3-year strategic plan - Ionia County Great Start Collaborative
Transcription
3-year strategic plan - Ionia County Great Start Collaborative
A Comprehensive Strategic Plan for Early Childhood Development in Ionia County January 2014 - December 2016 1 Table of Contents Guiding Principals……………………………………………….. 3 Letter to the Community ………………………………………… 4 Signature Page ………………….……………………………… 5 Membership ……………………………………………………. 7 Executive Summary …………………………………………….. 8 Guiding Principals ………………………………………………. 11 Great Start Collaborative Profile & History …………………….. 12 Strategic Analysis Findings ……………………………………... 14 Goals & Strategies ………………………………………………. 17 Action Agenda …………..……………………………………… 18 Financing & Fund Development ………………………………… 32 Appendices ………………………………………………………. 34 2 Guiding Principles of ICGSC Description of a Family We all come from families. Families are big, small, extended, nuclear, multigenerational, with one parent, two parents, and grandparents. We live under one roof or many. A family can be as temporary as a few weeks, as permanent as forever. We become part of a family by birth, adoption, marriage, or from a desire for a mutual support. As family members, we nurture, protect, and influence each other. A family is a culture unto itself, with different values and unique ways of realizing its dreams; together, our families become the source of our rich cultural heritage and spiritual diversity each family has strengths and qualities that flow from individual members and from the family as a unit. Our families create neighborhoods, communities, states and nations. ~ National Scientific Council Center on the Developing Child at Harvard University Guiding Principles Families in Ionia County are accepted as they are and supported to grow stronger. Families in Ionia County are empowered to utilize the knowledge, energy, health, and resources that they have at any given time. Families in Ionia County are honored, promoted and strengthened for their ethnic, social, structural, and cultural identities. Families in Ionia County are resources to the members of their families, agencies, and the community as a whole. Decisions in Ionia County will not be made without having consumer representation. A community assessment, based on required components was conducted; community conversations added a critical point-of-view to this process. The ICGSC updated the strategic plan, based on identified community needs and to be reflective of the unique makeup of Ionia County. The long term goal of the ICGSC is universal access to services for every Ionia County child and their family from birth through kindergarten entry. 3 Letter to the Ionia County Community ICGSC Members: To Th e C o m mu n i t y, Th e Io n i a C o u n t y G re at S t a rt C o l l ab o ra t i ve ( IC G S C ) h as b e en g r an t ed an o p p o rt u n i t y t o h av e a p o s i t i ve i mp a ct o n t h e f u t u re o f o u r yo u n ge s t ci t i zen s an d t h ei r f a mi l i e s . Th e f i rs t f i ve ye a rs o f a ch i l d ’ s l i f e c an r eap t h e g re at es t i n ves t m en t i n o u r f u t u re. Th e f i rs t f i ve ye ar s o f a ch i l d ’ s l i f e i s an o p p o rt u n i t y t o b u i l d a ch i l d ’ s b r ai n . Les s t h an ei gh t p e r cen t o f p u b l i c i n ves t men t s o n ed u cat i o n , ch i l d d e v el o p men t , an d o t h e r s u p p o r t s ar e t a r g et ed at t h i s a g e g ro u p ; wh i l e t h i s i s an i n c re as e f ro m f o u r p e rc en t , t h er e i s s t i l l w o r k t h at w e can d o . It i s f o r t h i s r e as o n t h e Mi ch i g an E ar l y C h i l d h o o d In v es t men t C o rp o r at i o n ( EC IC ) i n i t i at ed t h e G r eat S t a rt s ys t e m t o as s u r e a co o rd i n a t ed s ys t e m o f co m mu n i t y r es o u r ce s an d s er v i c es t o h e l p al l Mi c h i g an f a m i l i es wi t h ch i l d ren f ro m b i r t h t o a g e ei gh t . IC G S C h as b e en w o r ki n g t o s ecu re t h i s s ys t e m f o r t h e l as t f o u r ye a r s . Th e IC G S C w as f o r m ed f o u r ye a rs a go as a l o ca l p l an n i n g an d d ec i s i o n ma k i n g b o d y f o r t h e G r eat S t ar t S ys t e m. P res en t l y, t h er e ar e 5 4 Gr ea t S t a rt C o l l ab o rat i ves i n Mi ch i gan . In o rd e r t o m o re ef f e ct i v el y me et t h e n eed s o f ch i l d ren an d f am i l i es , t h e IC GS C co n d u ct s co m mu n i t y as s es s m en t s an d d e vel o p s an d u p d a t es a S t ra t e gi c P l an b as ed o n t h e f i n d i n gs o f an an n u al s ys t e m a s s es s m en t . Th i s wi l l b e t h e s e co n d s t r at e g i c p l an w e h a v e i mp l e men t ed . IC G S C b o ard m e mb e rs a re co m m i t t ed t o p ro v i d i n g co n t i n u ed l e ad e rs h i p s u p p o rt f o r acco mp l i s h i n g t h e i d en t i f i ed go al s o f t h e Io n i a C o u n t y G re at S t a r t C o l l ab o r at i v e. S u p p o rt i n g p a r en t s mat t e rs b ec au s e p ar en t s a re t h ei r ch i l d ’ s f i r s t an d b es t t ea ch e rs . Th e IC G S C w an t s t o co n t i n u e wo r ki n g o n d e v el o p i n g t h e b es t f o u n d at i o n p o s s i b l e f o r o u r yo u n g es t co m mu n i t y me mb er s . C h i l d ren wh o h av e ap p ro p ri at e med i ca l ca r e, co n s i s t en t an d s e c u re c ar e gi ve r, ad eq u at e n u t ri t i o n , an d a v a ri e t y o f ed u cat i o n al o p p o rt u n i t i es s u ch a s b ei n g re ad t o o r at t en d i n g p r es ch o o l a r e mo re l i k el y t o s u c ce ed i n s ch o o l an d l i f e. B y i n s i s t i n g o n q u a l i t y s er v i ces an d i mp ro vi n g co l l ab o rat i o n o f t h e s e r vi ces an d r es o u r ce s cu r ren t l y a va i l ab l e t o f a m i l i es , t h e go a l i s t o m a xi mi ze t h e i mp act o f f ed e ra l , s t a t e an d l o c al r es o u r ces t o b en ef i t ch i l d r en an d t h e i r f ami l i es . B y a g e s i x, 9 0 % o f a ch i l d ’ s co r e b r ai n s t ru c t u r e i s f o r med . S ad l y, l es s t h an 4 % o f p u b l i c i n ve s t men t s o n ed u ca t i o n , ch i l d d ev el o p men t , an d o t h e r s u p p o rt s a r e t ar g et ed at t h i s a ge gro u p . Th an k yo u f o r t a ki n g t i m e t o u n d ers t an d t h e go al s , amb i t i o n s an d p u rp o s e o f t h e IC G S C . Th e IC G S C m e mb e rs p rep ar ed t h i s p l an t o p r es en t t h e co m mu n i t y w i t h o u r v i s i o n , mi s s i o n an d act i o n a gen d a. Th e d a t a p res en t ed co mes f ro m a va ri et y o f s o u rc es u s i n g t h e l at e s t d a t a a va i l ab l e . W e w an t t o kn o w yo u r p ers p ec t i ve o n h o w we ca n s u p p o rt yo u an d yo u r f ami l y i n ge t t i n g yo u r ch i l d o f f t o a g rea t s t a rt . P l eas e c al l 6 1 6 - 5 2 2 -1 4 1 2 o r ch e ck o u r w eb s i t e a t G r eat S t ar t Io n i aC o u n t y. o r g t o b eco m e i n vo l v ed i n IC G S C act i vi t i es . We g r e at l y v al u e t h e co l l ab o ra t i o n i t t a kes t o s u s t a i n a co o rd i n at ed ef f o r t t o co n t i n u e t o b u i l d h ea l t h y, s t ro n g, an d s af e co m mu n i t i es f o r o u r f a mi l i es . We i n v i t e yo u t o j o i n u s i n o u r ef f o rt s ! S i n c er el y, C ar i O ’ C o n n o r, LM S W Io n i a & Mo n t ca l m C o u n t y G r ea t S t a rt C o l l ab o ra t i ve 4 Dr. Kathleen Ellsworth, DDS The Crayon Box Daycare Kids World Daycare Parents First Bank Enrich Temple Baptist Church Ionia County Health Department EightCap ICSAI RAVE Ionia County Department of Human Services Ionia County ISD Ionia Public Schools Saranac Community Schools United Way of Ionia County Ionia County Juvenile Court Ionia County Memorial Hospital Ionia County Economic Alliance Ionia County Community Mental Health Ionia County Friend of the Court Catholic Charities West Michigan Ionia County Literacy Council Central Region Resource Center For Health Family Resource Center 5 6 Membership Dr. Dorothy Berg Andrea Booker Dr. Beau Brainard , M.D. David Cook Dr. Kathleen Ellsworth Amanda Ferris Traci Flanner Cheryl Granzo Elijah Harris Heather Jackson Christa Jerome Bob Kjolhede Heather Knapp Robert Lathers Darin Magley Josh Mason Lisa McCafferty Kevin Meade Tabatha Mitchell Nancy Sherd Cari O’Connor Robert Ranney Keegan Rice Erin Roberts Jessica Rowland April Ruehs Nancy Secor Michelle Seigo Jason Smith Hon. Robert Sykes Deb Thailson Roger Thelen Laurie Tjalsma Deborah Trierweiler John VanNieuwenhuyzen Danielle West Norine Andrews Nicole Marzic 7 Executive Summary The Ionia County Great Start Collaborative (ICGSC) has engaged many service providers, parents, and community members to support the mission and vision of the ICGSC. These statements guide our work as we continually assess our progress. We review the current data and state of our county to ensure that our vision becomes reality for birth to eight children and their families. Mission: To develop a seamless system of care that utilizes community resources and supports, to help our families have access to the tools needed to provide a healthy start for all children birth to kindergarten entry. Vision: Children in Ionia County are healthy, eager, and prepared to succeed in school and life. Our community assessment revealed data that indicated great challenges for many young children and their families. In Ionia County, we have seen a decline in our child population, however more of our children are living in poverty than ever. This would indicate that many families are having trouble meeting economic basic needs. Also the higher percentage of families eligible for temporary assistance for needy families (TANF) mean that the time limits on benefits through the Department of Human Services in 2012 had a big impact in our communities. Ionia County had the highest percentage drop in FIP cases of all Michigan counties, with a 48% drop. 8 Executive Summary Basic economic needs like food and shelter continue to be a theme in our community conversations. Medical and dental assistance were areas that families continue to struggle with; also in Ionia County, we saw a 2.8% increase in our babies being born without or only late prenatal care. This data also shows Ionia County is higher than the state average (13.9%) having people with out health insurance at 14.9%. Families without health insurance are still using emergency room services to address their medical an dental needs. Concerning areas (higher than the state average statistics) for our children in Ionia County also involve physical and social emotional health. We continue to have a higher number of obese children at 15.4%. Economic woes seem to start at birth with 46% of births in Ionia County being paid for by Medicaid. This means that 46% of children are born into poverty in Ionia County. We have seen a dramatic increase in the number of children birth to five where these is substantiated child abuse and neglect. Up from 18.25% to 25.7% in the most recent reported years, We are above the state average of 13.8% by 11.8%. Ionia County also has a 49.6% rate of children in K-12 that are eligible for free or reduced school lunch programming. Basically, almost half of our school age children are born and continue to live in poverty. Substance abuse continues to be on the rise along with our cases of neglect and abuse. In a national study, 50 to 80 percent of the child abuse and neglect cases dealt with parents or care givers with substance abuse issues. Children living in these circumstances often arrive at kindergarten unprepared and those that start behind are more likely to stay behind. 9 Executive Summary Ionia County continues to bring many forces together to lay a strong foundation for our children. For the last three years the members of the ICGSC have met tighter to attempt to find solution to basic needs supports, homelessness, lack of preschool opportunities, limited access to health care, access to healthy living supports, and teen pregnancy. Great strides have been made in Ionia County. The percentage of Women's infant and children program reported overweight or at risk of being overweight is down from 2011. Ionia County has seen a decrease in teen parent population for the first time in many years. Repeat teen births are also down by 4%. Immunization rates continue to be over the state average at 81%. Low weight at birth is below the state average as well. More free or reduced cost preschool opportunities are available than ever before. ICGSC has joined forces with several initiatives to bring birth to eight families to the fore front. The Ionia County Substance Abuse Initiative, the Ionia Health Plan, and 211 initiatives are just a few examples to the partnerships established with the ICGSC in an effort to have a positive impact on the lives of families in Ionia County. The highest priority continues to be the provision of quality services and supports for birth to eight families in Ionia County. The ICGSC is independently evaluated through Michigan State University every two years. 2012 ICGSC evaluation results were impressive. The strongest areas of our ICGSC work according to the survey participants were intentional systems change actions, establishing effective partnerships, and building parent leadership in our community. Areas that we will target for improvement were creating a strong relational network and increasing the number of active constituents in the ICGSC work. The ICGSC improved in all fourteen outcomes from 2010. All levels of change for building a strong early childhood system saw significant improvements. The ICGSC results for authentic parent voice and movement in all the levels of change were recognized at the state level. 10 Guiding Principles Families in Ionia County are accepted as they are and supported to grow stronger. Families in Ionia County are empowered to utilize the knowledge, energy, health, and resources that they have at any given time. Families in Ionia County are honored, promoted and strengthened for their ethnic, social, structural, and cultural identities. Families in Ionia County are resources to the members of their families, agencies, and the community as a whole. Decisions in Ionia County will not be made without having consumer representation. A community assessment, based on required components, has been conducted; community conversations added a critical point-of-view to this process. Enclosed in this document is a completed strategic plan, based on identified community needs and reflective of the unique makeup of Ionia County. The long term goal of the ICGSC is universal access to services for every Ionia County child and their family from birth through kindergarten entry. Child development professionals, special educators, social workers, health care providers and support staff all agree that the Ionia County Great Start Collaborative have the level of collaboration and coordination of early education and care opportunities available for Ionia County’s youngest children. From board members to front line workers, the highest priority continues to be the provision of quality services to birth to five population. 11 Profile The Ionia County Great Start Collaborative (ICGSC) has created a foundation that ensures that all children in Ionia County arrive to kindergarten healthy, safe, and ready to succeed in school and life. Years of previous efforts, commitment, and interagency collaboration have helped lead the way in creating this foundation. The Ionia County Great Start Collaborative membership consist of parents, public health, human services, community mental health administrators, k-12 system representatives, preschool representatives, child care providers, charitable organizations, business leaders, faith based leaders, elected and public officials, minority leaders, and other community leaders. These partners are dedicate to creating a quality early childhood system in Ionia County. 12 Profile Highlights and Accomplishments August 2008 - Ionia County Intermediate School District applied for the Great Start Collaborative Start Up Grant. September 2008 - Ionia County ISD was awarded the Great Start Collaborative Start Up Grant. October 2008 - Formal Interagency agreements were signed. December 2008 - Formation of Executive Committee of the ICGSC with Operating Guidelines. November 2008 - The Great Start Collaborative committee needs identified. December 2008 - GSC communications Committee formed, public relation/outreach of the importance of early childhood supports and system planning implemented. December 2008 - First Formal ICGSC meeting held. January 2009 - The Parent Coalition of Ionia County developed. May 2009 - The first Parent Coalition meeting was held. May 2009 - The ICGSPC attended their first Star Power Day. November 2009 - First of many Mom 2 Mom sale held in Ionia County. December 2009 - The ICGSPC host their first annual Reading with Santa event. December 2009 to October 2010 - Strategic Planning process for ICGSC occurred. Plan Approved. May 2010 - Star Power Day. August 2010– First Ice Cream Social was held in partnership with Eight Cap Inc. September 2010- First Kindergarten Round up surveys were completed and report distributed. November 2010 - ICGSPC hosts a candidate forum. November 2010 - The ICGSPC won the Cool Communities Contest through Michigan 1. February 2011 - ICGSPC toured the Capitol and Legislator Mike Callton’s office. March 2011 - The first Parenting Awareness Month activity was held. May 2011 - The ICGSPC was awarded the Fierce Heart Award at Star Power Day. August 2011 - Ice Cream Social held in partnership with Eight Cap Inc. September 2011 - Virtual Bus tour was completed and distributed to all community leaders. October 2011 - The ICGSC Director position merged with the Montcalm County GSC. January 2012 - The ICGSPC becomes the planning committee for Parenting Awareness Month Activities. March 2012 - 2nd Annual Parenting Awareness Month Activity is held with legislator April 2012 - First Touch a Truck event held. May 2012 - Star Power Day. May 2012 - ICGSC participates in local community garden efforts. August 2012 - Annual Ice Cream Social in partnership with EightCap Inc. October 2012 - The ICGSPC holds their first Parent Café. November 2012 - The ICGSPC won the Cool Communities Contest through Michigan 1. January 2013 to October 2013 - Strategic Planning process for the ICGSC Occurred. Plan Approved. March 2013 - Annual Parent Child Dance held. May 2013 - Star Power Day August 2013 - Annual Ice Cream Social in partnership with EightCap Inc. 13 Strategic Analysis Findings The Ionia County Great Start Collaborative collected and reviewed data specific to our community in the area of Community Conditions, Early Care and Education, Family Support, Physical Health Care and Social Emotional Health. This data collection included complied surveys from Kindergarten Roundup in all five school districts, a Health Status Assessment from the Sparrow Ionia Hospital and 20 Community Conversations with over 200 birth to five parents participating, to gain the perspective of our partners on current community conditions and priorities for the five subject areas. What we learned for each: Community Conditions of Ionia While there are fewer children in Ionia County compared to the 2005 Census data, the economic security of children in Ionia County has worsened since the last Strategic Review for most indicators. More children are in poverty, more are receiving free or reduced lunches at school, and more are receiving SNAP food assistance than in 2007. Despite this growing economic hardship, Ionia County reported the greatest percentage drop (of 48%) in families receiving FIP Cash Assistance through DHS. Finally, unemployment in Ionia is at 8.3% for 2012, compared to a pre-recession 7.2% in 2005. These community conditions are the reason, the ICGSC set a high priority for supporting families through initiatives to make affordable and accessible family supports such as basic needs supports, including physical, social and emotional health available, and affordable, quality early education and child care. On the community health conditions, there was more of mixed results in trends. Ionia County has seen a decrease in teen parent population, with repeat teen births down by four percent. There is also a reduced percentage of WIC children classified as either over- weight or at risk of being overweight in 2012 compared to 2011. There is an increase in immunization rates-- which at 81.0% for those 15 to 35 months, is higher than the state rate of 75.0%. Unfortunately, the county DHS data shows a dramatic increase in the number of children age 0 – 5 where substantiated child abuse and neglect has been reported – 25.6%, up from 18.25%. This is substantially higher than the statewide average of 13.8%. Overall, more persons in Ionia are without health insurance (at 14.9%) than statewide (at 13.9%). Overall, obesity in children is also higher in Ionia than statewide. Early Education and Child Care Factors Two themes emerged from the community conversations on Early Education and Child Care Factors. The Ionia community believes strongly in early care and education being a key to future success. As such there is a high priority to have quality early childhood education opportunities available to all, including those facing economic hardships. Having more preschool available was the second highest ranked factor identified by Café Conversation participants on what is needed to improve children’s school readiness. Early Childhood programming was ranked highest for what participants felt the community could do better on. Increasing playgroup opportunities also came up during this strategic planning process and our last strategic planning process. 14 Strategic Analysis Findings Results also clearly expressed that parents are the key to child readiness. Parents have to believe early childhood education matters and have, as parents, the skill sets to do their part. Ionia stakeholders identified continued advocacy to support expanding quality early child- hood education opportunities in Ionia County as important to providing access. Parents being ready with these skills was ranked as the top factor in improving school readiness by Café Conversation participants. Budget cuts to early education and family supports are the third highest challenge facing the community according to the Café Conversation participants. Family Support Factors With the emphasis on the parents’ role in early childhood development and the economic insecurity of a significant portion of families in Ionia, the community identified a lack of supports for families to have access to the skills and training they need to do their part in quality childhood development. This included a need to do more to connect and link parents to current resources and well as expanding resources available to meet parents’ needs. Lack of knowing resources available was identified as the biggest challenge by the Café Conversation participants. Funding for 211 continues to be an issue. This could leave 180 plus families without resources and referral information. Physical Health Factors The community strongly believes that healthy children are key to having a successful future. The biggest challenge to this future success identified by Café Conversation participants was obesity rates for children, but dental health, mental health and immunization rates were also mentioned. The documented significant increase in abuse and neglect cases in Ionia County was identified as a new health factor that needed to be addressed, as was bullying. The lack of access to health care for families (from the health indicator of above statewide rates of uninsured) was also identified as a barrier to achieving the health families deserve. Lack of insurance and health care that needs to be addressed, particularly through increased partnerships. Social Emotional Health Factors Access to social emotional support, particularly access to mental health services was identified as an area the community needed to do better on by Café Conversation participants. Two new social emotional health factors identified through the data gathering process was the need to address bullying of children and the need to address the social and emotional impact of the high abuse and neglect cases substantiated within Ionia County. As identified by participants, the social and emotional supports need to be available to parents as well as children. Ionia County has seen an influx of providers of mental health services in the past 3 years, yet it is still labeled as a mental health provider shortage area. 15 Strategic Analysis Findings Priorities and Pressing Issues for Ionia County Children ages birth to 8 Wellness Childhood Obesity High numbers Confirmed Abuse and Neglect Cases Lack of supports for Social Emotional Development Substance Abuse Concerns Family Support Need more Parent Support for basic needs: employment, early literacy supports, health care, family support and access to early childhood education supports. Early Education and Child Care Lack of affordable, Quality Preschools for 3 year olds Need more affordable, local opportunities to improve quality for child care providers Lack of access to quality child care providers 16 Goals and Strategies: Goal 1: Maintain the infrastructure of the ICGSC. Objective 1: Maintain engagement and effectiveness of the ICGSC Board. Objective 2. Educate Ionia County Communities about Early Childhood Investment. Objective 3. Create blended funding opportunities in Early Childhood system in Ionia County. Objective 4. Maintain a coordinated early childhood advocacy message in Ionia County. Goal 2: Improved wellness for children prenatally through age eight. Objective 1: Develop wellness supports for birth to eight families in Ionia County. Objective 2. Improve wellness supports access for birth to eight families. Objective 3. Build partnerships to create family support opportunities. Goal 3: Children in Ionia County are prepared to succeed in school. Objective 1: Create affordable opportunities for families to support their needs. Objective 2. Promote affordable, quality preschool experiences in Ionia County. Objective 3. Build partnerships to promote educational opportunities for caregivers Goal 4: Families support and guide the learning of birth to eight children. Objective 1: Build parent supports into the Ionia County Early Childhood System. Objective 2: Strengthen collaboration between referral sources. 17 Action Agenda The action agenda is in a grid format and covers the following for each identified goal: Strategy Objective Resource Needs Roles and Responsibilities Target Dates 18 Goal 1: Maintain the infrastructure of the ICGSC. Office of Great Start Outcome: Children healthy, thriving, and developmentally on track from birth to grade three. Strategy 1: Maintain engagement and effectiveness of the ICGSC Board. Action Steps a) Maintain Membership Corner b) Develop Parent Board member recruitment tools; including web based tools Resource Needs Staff time Staff time Volunteer time Printing Roles/ Responsibilities ICGSC Director & Executive Committee ICGSC Director & Parent Coalition Target Dates & Time frame January 2014December 2016 June 2014 c) Maintain Membership profile and MOU’s for all ICGSC board members Staff time Volunteer time ICGSC Director January 2014December 2016 d) Continue Parent Financial Supports to address barriers as identified Staff time Funding source Staff time Funding source ICGSC Director & Executive Committee ICGSC Director & Executive Committee January 2014December 2016 January 2014December 2016 e) Provide supports to address barriers for parent participation. Strategy 2. Educate Ionia County Communities about Early Childhood Investment 19 Progress Measures Principles of Collaboration Survey results Over 20% parent participation on ICGSC Parent member on each committee Annual completion & Membership numbers MSUE results: participation benefits Percentage of budget at 50% Parent Support Percentage of parent Participation MSUE results: Authentic Voice Status Review Action Steps Resource Needs Staff time Printing Funding source Roles/ Responsibilities ICGSC Director & Executive Committee Target Dates & Time frame January 2014December 2016 b) Maintain Website supports to promote early childhood. Staff time Volunteer time Funding source ICGSC Director & Executive Committee Ionia ISD Tech January 2014December 2016 c) Create early childhood investment kits for Ionia County distribution. Staff time Printing Funding source ICGSC Director & Executive Committee January 2014December 2016 a) Conduct media campaigns that include billboards, radio, and newspaper activities. Progress Measures Number of increased contacts & hits as a result as reported in the quarterly reports MSUE results: Parents Needs Met Number of unique visits as reported in the quarterly reports MSUE results: Improved Early Childhood Systems & Parents Needs Met Tools distributed in conjunction with number of hits on website & new contracts added per Quarterly reports MSUE results: Improved Early Childhood Systems Status Review Strategy 3. Create blended funding opportunities in Early Childhood system in Ionia County. Action Steps Resource Needs Roles/ Responsibilities 20 Target Dates & Time frame Progress Measures Status Review a) Partner with the ICSAI plan implementation Staff time Volunteer time ICGSC Director January 2014December 2016 b) Parent Participation on the 211 Advisory Board. Staff time Funding source ICGSC Director January 2014December 2016 c) Parent Participation on the IoHP Advisory Staff time Training Funding source ICGSC Director d) Maintain and Support Montcalm and Ionia Shared Committee Activities Staff time Volunteer time Printing Training Funding source Executive Committee ICGSC Director f) Create ICGSC board member shared funding projects Staff time Funding source Executive Committee ICGSC Director 21 Number of joint projects that are created Number of support opportunities from parent participation created MSUE Evaluation Results: Parents Needs Are Met January 2014Parent attendance December at meetings 2016 Meeting minutes MSUE Evaluation results: More Responsive Community Context January 2014Number of shared December MI activities 2016 implemented: MSUE Evaluation results: More Responsive Community Context January 2014Number of ICGSC December 2016 shared funding opportunities created MSUE Evaluation results: Improved Early Childhood System Strategy 4. Maintain a coordinated early childhood advocacy message in Ionia County. Action Steps Resource Needs Staff time Volunteer time Printing Training Roles/ Responsibilities Parent Coalition ICGSC Director Target Dates & Time frame January 2014December 2016 b) Implement Social Media new activities Staff time Volunteer time Training Executive Committee ICGSC Director 2015 c) Create and distribute new materials developed by parents for parents Staff time Volunteer time Printing Training Executive Committee ICGSC Director Parent Coalition January 2014December 2016 d) Encourage ICGSC logo and link on ICGSC board members web sites Staff time 2014 e) Produce annual Status of Young Child Report Staff time Volunteer time Printing Executive Committee ICGSC Director Executive Committee ICGSC Director Parent Coalition a) Continue legislative advocacy efforts at local and state level 22 January 2014December 2016 Progress Status Review Measures Elected official feedback to parents Elected official participation in ICGSC activities Number of Social media events Number of new contacts increased Number of materials created Parent feedback survey MSUE Evaluation results: More Responsive Community Context Number of access avenues to the ICGSC web Report created and utilized in planning MSUE Evaluation results: More f) Promote Sandbox Party Activities Staff time Volunteer time Printing Parent Coalition Parent Liaisons January 2014December 2016 Responsive Community Context Number of Sand Box party members in Ionia County Goal 2. Improved wellness for children prenatally through age eight. Office of Great Start Outcome: Children born healthy. Strategy 1: Develop wellness supports for birth to eight families in Ionia County. Action Steps Resource Needs Staff time Volunteer time Printing Roles/ Responsibilities Early Education and Child Care Committee Target Dates & Time frame January 2014December 2016 b) Initiate Physical Health events for kids/families Staff time Volunteer time Printing Funding source Wellness Committee January 2014December 2016 c) Prenatal Smoking cessation promotion tool distributed Staff time Volunteer time Printing Wellness Committee 2015 a) Promote active living and healthy eating though education, policy and environment changes with child care providers 23 Progress Measures Number of child care providers participating Number of children impacted per quarterly report Number of participants : children impacted per quarterly report % of WIC children reporting obesity or at risk Number of requests for tool Number of participants Status Review Strategy 2. Improve wellness supports access for birth to eight families. Action Steps Resource Needs Staff time Volunteer time Printing Funding source Roles/ Responsibilities ICGSC Director Parent Liaisons Parent Coalition Wellness Committee Target Dates & Time frame January 2014December 2016 b) Distribute pediatric dentistry materials in Ionia County Staff time Volunteer time Printing Funding source Parent Coalition Wellness Committee January 2014December 2016 c) Community Awareness campaign regarding Affordable Care Act Staff time Printing Training Wellness Committee Parent Coalition 2014 d) Continue implementation of dental health campaign Staff time Volunteer time Printing Funding source Wellness Committee January 2014December 2016 e) Update and maintain Social/Emotional Resources Information. Staff time Volunteer time Printing Wellness Committee 2015 a) Develop partnerships with local dental and physical health providers 24 Progress Measures Number of new partnerships developed % of women with inadequate prenatal care per Kids Count Number of free materials provided Number of children served per quarterly report Parent survey results Number of no insurance reports reduced Number of free materials provided Number of families impacted per quarterly report Number of resources developed & distributed Status Review f) Build farmers market and food pantry connections. Staff time Volunteer time Printing Wellness Committee 2015 Number of farmers markets and food pantry partnerships Strategy 3. Build partnerships to create family support opportunities. Action Steps a) Support bullying prevention activities for birth to five families. b) Create Nutrition Night activities in partnership with ICGSC board members c) Support partnerships to provide awareness of healthy eating education d) Early Childhood Celebration in partnership with Head Start e) Increase access to birth to five services through the implementation of the Resource Needs Staff time Volunteer time Printing Training Funding source Staff time Volunteer time Printing Funding source Staff time Volunteer time Printing Roles/ Responsibilities Parent Coalition Target Dates & Time frame 2014 Progress Measures Number of partnerships developed Number of children impacted Wellness Committee 2014 Number of participants Number of partners supporting Wellness Committee January 2014December 2016 Number of supports implemented Staff time Volunteer time Printing Funding source Staff time Volunteer Family Support Committee 2014 Number of children impacted Wellness Committee January 2014December Number of children 25 Status Review Connections Program. f) Coordinate an annual Parenting Awareness Activity. g) Advocate for social emotional health component in all Ionia County parenting classes. h) Increase the number of trainings on social emotional interventions that include parents & Child care providers. time Printing Funding source Staff time Volunteer time Printing Funding source Staff time Volunteer time Printing Training Funding source Staff time Volunteer time Funding source ICGSC Director Parent Liaisons 2016 registered Wellness Committee Parent Coalition January 2014December 2016 Number of children impacted Parent Coalition Wellness Committee 2016 Number of parenting classes participating Number of children impacted Wellness Committee Early Education & Child Care Committee January 2014December 2016 Number of participants Survey results GOAL 3: Children in Ionia County are prepared to succeed in school. Office of Great Start Outcome: Children ready to succeed in school at time of school entry and prepared to succeed in fourth grade and beyond by reading proficiently by the end of third grade. Strategy 1: Create affordable opportunities for families to support their needs. Action Steps a) Continue to provide Welcome Home Baby Resource Needs Staff time Roles/ Responsibilities Early Education 26 Target Dates & Time frame January 2014- Progress Measures Number of Status Review packets in community Volunteer time Printing Funding source Staff time Volunteer time Printing and Child Care Committee Parent Liaisons ICGSC Director December 2016 Early Education and Child Care Committee Parent Liaisons ICGSC Director January 2014December 2016 c) Increase access to and promote learning opportunities for families with young children (I.e. playgroups, topic specific support groups etc.) Staff time Funding source Early Education and Child Care Committee 2015 d) Promote and support literacy in the home through (ie. Dolly Parton Imagination Library, Ready Kits, Literacy Council, donation programs ) Staff time Volunteer time Printing Early Education and Child Care Committee Parent Coalition January 2014December 2016 e) Staff time Volunteer time Printing Training Funding source Early Education and Child Care Committee Parent Coalition 2016 b) Coordinate Preschool Partnership activities Explore partnerships with early childhood providers to assure children that need special education services have access to preschool programming. 27 partners distributing MSUE Evaluation results: Parents Needs are Met Number of children served in free preschool opportunities MSUE Evaluation results: Relational Networks Number of children served in opportunities MSUE Evaluation results: Improved Early Childhood System Number of children impacted DPIL Annual survey MSUE Evaluation results: Parents Needs are Met Number of children served MSUE Evaluation results: Improved Early Childhood System Strategy 2. Promote affordable, quality preschool experiences in Ionia County Action Steps Resource Needs Staff time Volunteer time Printing Training Funding source Staff time Volunteer time Printing Roles/ Responsibilities Early Education and Child Care Committee ICGSC Director Target Dates & Time frame 2014 Progress Measures Number of partners involved Number of tools created Early Education and Child Care Committee Parent Coalition January 2014December 2016 c) Promote and expand joint recruitment opportunities and community partners ( i.e. private preschool free/low cost opportunities) Staff time Volunteer time Printing Early Education and Child Care Committee Executive Committee January 2014December 2016 d) Continue Starfish Preschool Scholarship Staff time Funding source Staff time Printing Training Funding source ICGSC Director Executive Committee Early Education and Child Care Committee Executive Committee January 2014December 2016 January 2014December 2016 Number of contacts increased MSUE Evaluation results: Responsive Community Joint recruitment application numbers MSUE Evaluation results: Responsive Community Number of scholarships provided Number of 3 & 4 year olds in preschool MSUE Evaluation results: Improve Early Childhood System a) Create tools to support transitions between preschool and kindergarten programming. b) Continue campaign/messaging to educate parents on the importance and benefits of attending preschool. e) Increase availability and access for 3 and 4 year olds to attend quality preschool programs 28 Status Review Strategy 3. Build partnerships to promote educational opportunities for caregivers Action Steps Resource Needs Staff time Volunteer time Printing Roles/ Responsibilities Early Education and Child Care Committee ICGSC Director Target Dates & Time frame January 2014December 2016 Progress Measures Number of partners Number of participants b) Promote ICGSC web site calendar for early childhood training & activity information. Staff time January 2014December 2016 Number of partners c) Partner with a Regional Resource Center to promote local, quality training opportunities and supports. d) Establish the 0-3 Community of Practice Staff time Early Education and Child Care Committee ICGSC Director Early Education and Child Care Committee Early Education and Child Care Committee January 2014December 2016 Early Education and Child Care Committee Number of supports provided a) Annual Professional Development schedule that provides free or low cost local trainings for parents and providers. Staff time Printing Status Review Number of participants MSUE Evaluation results: Strong Relational Network Goal 4: Families support and guide the learning of birth to eight children in Ionia County. Office of Great Start Outcome: Children healthy, thriving, and developmentally on track from birth to grade three. Strategy 1: Build parent supports into the Ionia County Early Childhood System. Action Steps a) Publish Family Fun Guide Resource Needs Staff time Volunteer time Roles/ Responsibilities Family Support Committee 29 Target Dates & Time frame January 2014December 2016 Progress Measures Number of families impacted Status Review b) Promote web site to support parent’s access to local early childhood activities. c) Promote community garden opportunities. d) Secure and maintain funding for resource and referral service (211) in Ionia County. e) Maintain parenting class opportunities. f) Coordinate diaper drive activities. g) Create tool to identify agencies that Printing Funding source Staff time Volunteer time Funding source Staff time Volunteer time Printing Training Funding source Staff time Volunteer time Printing Funding source Staff time Volunteer time Printing Funding source Staff time Volunteer time Printing Funding source Staff time Family Support Committee ICGSC Director January 2014December 2016 Add counter option: Number of unique visitors Family Support Committee Wellness Committee January 2014December 2016 Number of partnerships developed Family Support January 2014December 2016 211 funding obtained MSUE Evaluation results: Parents Needs are Met Family Support January 2014December 2016 Number of parenting class opportunities Family Support January 2014December 2016 Number of diaper supports Family Support 2015 Number of 30 provide birth to eight basic needs supports. Volunteer time Printing Funding source partnerships developed to create tool Strategy 2: Strengthen collaboration between referral sources. Action Steps a) Host networking activities between service providers. b) Establish connection to Ministerial association in Ionia County. c) Conduct Mandated Reporter training d) Partner with the Continuum of Care: Housing Connect Event Resource Needs Staff time Volunteer time Printing Funding source Staff time Printing Roles/ Responsibilities Family Support Committee Target Dates & Time frame 2015 ICGSC Director Parent Liaisons 2014 Staff time Volunteer time Printing Funding source Staff time Volunteer time Printing Family Support Committee 2015 Number of participants Parent Liaisons Family Support Committee 2014 Number of families impacted 31 Progress Measures Number of participants MSUE Evaluation results: Strong Relational Network Number of supports as a result MSUE Evaluation results: Strong Relational Network Status Review Financing and Fund Development The Ionia County Great Start Collaborative has identified six goals that need to be addressed in order to achieve our vision that “Children in Ionia County are healthy, eager, and prepared to succeed in school and life.” In order for the ICGSC to accurately address the issues through the identified goals, strategies, and action agenda we will need following resources: * Human Capital * Local Funding Sources * In Kind supports * Assessment and Data Systems Human Capital: The ICGSC Executive Committee has established the following committees to assist them in addressing each of the goal areas in the action agenda: * Early Education & Child Care Committee * Family Support Committee * Parent Leadership Committee * Family Wellness Committee * Executive Committee The committees are chaired by individual ICGSC board members from different sectors in Ionia County and include at least one parent representative. Each of these committees meet a minimum of six times per calendar year to address the strategies outlined in the action agenda to ensure measurable results. Financing and Fund Development: Committees will provide a report on work and progress at each ICGSC Board Meeting. Executive Committee membership is comprised of members who have the authority to commit funds, staff and other resources on behalf of his/her organization. Partnerships will be maintained with existing early childhood, agencies and business organizations. Additional partnerships will be made through the work of all the committees with other key stakeholders in the community who support the vision and mission of the Ionia County Great Start Collaborative. Annually, each participating member of the ICGSC Board will have a signed Memorandum of Understanding document on file with the ICGSC Director. Local Funding Sources: Financial support will be needed to adequately address the action agenda and goals. The Ionia County Great Start Collaborative, ICGSC Director, ICGSC Chair, Parent Support Team, and the Executive Committee, will secure and maintain local funding by developing relationships with local community foundations, businesses, and key stakeholders in the county to solicit financial investment in early childhood systems and supports. The ICGSC Board members will also explore grant opportunities available for early childhood related initiatives. ICGSC board members will commit financial supports as available to support the work of the action agenda. 32 Financing and Fund Development The ICGSC will continue to solicit financial investment in early childhood systems, services, and supports from all early childhood partners as well as the business community at large. The ICGSC Board will continue to advocate for the completion of the Action Agenda through increased revenue sharing, partnerships in training and service delivery efforts, as well as in-kind supports. Assessment and Data Systems: The Ionia County Great Start Collaborative recognizes that a system is necessary to support information sharing and evaluation of the strategies outlined in the Action Agenda. The Executive Committee works with all collaborative member agencies and organizations to determine the current capabilities for data sharing to guarantee up to date and accurate data for the ongoing collaborative work of the ICGSC. Information is stored on the ICGSC website to support assessment and open data sharing. 33 Appendices Appendix A: Ionia County Great Start Collaborative Strategic Planning Process Appendix B: Status of Young Children Report Appendix C: Collaborative Strategic Planning Outline Appendix D: EightCAP Report Appendix E: Head Start Comprehensive Community Needs Assessment Appendix F: Ionia County Community Mental Health Consumers Served Report Appendix G: Ionia County Health Department Brief Appendix H: Ionia County Behavioral Risk Factor Survey Appendix I: Great Start Initiative Executive Summary Appendix J: About the Great Start Evaluation Appendix K: Executive Summary Reflection Questions Appendix L: Ionia County Great Start Collaborative Strategic Planning Presentation Appendix M: Ionia County Kids Count 2012 Data Appendix N: Kindergarten Roundup 2012 Report Appendix O: Ionia County Kids Count 2013 Data Appendix P: Sparrow Ionia Hospital Community Needs Health Assessment Appendix Q: Dolly Parton Imagine Library Survey Results Report 2012 Appendix R: Ionia County Department of Human Services Fact Sheet 34 Ionia County Great Start Collaborative 2012-13 Strategic Planning Process During the Fall of 2012 the Strategic Planning update process began for the ICGSC board members and the Ionia County community. The Ionia County Great Start Collaborative collected and reviewed data specific to our community in the area of Community Conditions, Early Care and Education, Family Support, Physical Health, and Social Emotional Health. The data collection included many sources of local and state data sources. During the year ICGSC board members participate in Data Sharing activities at each board meeting. This data along with other resources was reviewed during the Strategic Planning process. At board meetings throughout the fiscal year strategic planning activities were completed to assist with creating an effective updated plan. Data examples that were used in the strategic planning process to gain the perspective of on our current community conditions and priorities for the next three years were the complied surveys from Kindergarten Roundup in all five school districts, a Health Status Assessment from the Sparrow Ionia Hospital and 20 Community Café Conversations (with over 200 birth to five parents participating). Community Café Conversations’ were hosted at all of the geographic areas with in Ionia County at existing activities with in ICGSC partner building such as the elementary schools and the Ionia Intermediate School District. Information was made accessible in a variety of formats for parent input to be collected. The Café Conversation surveys were posted on Facebook, on line on the ICGSC website, and sent out via email to our list serves. 200 Ionia County birth to five parents participated in our Community Café Conversations for the strategic planning process. New partnerships were formed during this process. As a result, local libraries hosted events for parents to participate in our strategic planning process. After the Parent Liaisons facilitated 20 community conversations with in Ionia County in the 2013 early winter; ICGSC board members designated time in their regularly scheduled board meetings such as “Spend a Buck” and “Keep; Modify; or Delete” activities in order to help prioritize the valuable information that was obtained from the community. In the spring of 2013 the Executive Committee determined that a facilitator was needed to assist with two specific ICGSC board meeting activities. The facilitator was contracted to assist with strategic data analysis. The data analysis compiled information was utilized in two board meeting conversations to allow for meaningful, honest conversations about the direction of early childhood services and supports in Ionia County. See included power point from the ICGSC board meeting discussion. Goals, objectives (strategies), and activities were identified at the board level. Once this occurred the existing ICGSC committee’s took the information back to their committee meetings during the months of July and August in the summer of 2013 to finish the identified strategies and activities needed to accomplish the identified goals for the ICGSC Strategic Plan. Appendix A 35 ICGSC Board Meeting results 2013 36 Community Café Conversation Compiled Results 37 Dear Community Member, We know that the first five years of a child’s life lay the foundation for language, social behavior, problem solving, ability, and other important brain developments. This time is an opportunity to build our young children's brains. As a community there are still so many things that we can do to support parents in their efforts to raise healthy children. Research tells us that by age six, ninety percent of a child's brain will be built. Supporting parents matters because parents are their child's first and best teacher. Parents and community leaders in Ionia County who understand the vital importance of investing in young children continue to work together to implement the next strategic plan of the Ionia County Great Start Collaborative (ICGSC). The ICGSC works to build an Early Childhood system that families can navigate to get their needs met. This system building initiative hopes to make changes to support families and children during the most impactful time of a child’s life. The ICGSC has had many successes over the last 3 years. Increasing preschool opportunities, local access to a pediatrician and OBGYN, and partnering with local businesses to create family friendly community activities are just a few things that the ICGSC has supported. We understand wise investments need to be made now in order to ensure that our children will be successful adults. The Ionia County Early Childhood Action Agenda focuses our attention and helps us develop a blue print to improve the outcomes for our 4,922 children ages birth to five or for the 785 new births during 2011. This 2012 report is the fourth report that the ICGSC has prepared to present information about our community and our young children. The data presented comes from a variety of sources using the latest data available. These references are included in the back of this report. We want to know your perspective on how we can support you and your family in getting your child off to a great start. Please call 616-522-1412 or check our website at GreatStartIoniaCounty.org to become involved in this effort. We invite you to join us in our efforts! Sincerely, Ionia County Great Start Collaborative Appendix B 38 The Status of Young Children in Ionia County THE ISSUES: 20.7% of children ages birth to eighteen live in poverty. 47.6% of our students receive free or reduced school lunch assistance. 33% of Ionia County mothers who gave birth did not receive appropriate health care. This is an 11% increase from last year’s reporting. 4.4% of mothers report they had late or no prenatal care; up from 2.8%. Ionia County has seen a decrease in our teen parent population for the first time in many years. The percentage of Repeat teen births is 16.4%, down 4%. 45.2% of Ionia County births are paid for by Medicaid. 54.4%% of children ages 1-4 are participating in WIC. 7% of children ages 2-5 that are enrolled in Women’s, Infant and Children (WIC) supplements in Ionia County were overweight or at risk of becoming overweight. This number is down from 2011’s 23%. Ionia County continues to see a dramatic increase in the number of children birth to five that were substantiated for child abuse and neglect. From 18.2% in 2009 to 25.6% in 2010. The state average is 13.8%. Entire Report Data Sources: Community Level Information on Kids (CLICKS), Michigan Kids Count Ionia County Great Start Collaborative and Great Start Parent Coalition are the focal point for local early childhood efforts. For more information about early childhood in Ionia County or to provide feedback regarding this data, please go to: www.GreatStartIoniaCounty.org 39 Physical Health Strengths Good doctors 211 Direct relation to academic success Problems Services aren’t available for kids with Medicaid transportation issues cost of activities technology replacing activity Threats state budget issues Affordable Care Act only lasts 2 years Lack of programming Opportunities Affordable Care Act More education for healthy lifestyles resources on available doctor options Social Emotional Health Strengths MHP’s for foster youth – opp for mental health services Dolly Parton Imagination Library Drug Court Growing/Stable prevention programs at DHS Extension with voluntary Foster Care for older youth Opportunities Collaboratives in community researching possible alternative ed program: JAG MY01 Problems Increase in confirmed youth afflicted with abuse and/ or neglect decrease in counselors in schools, also nurses in schools Homelessness/unemployment Threats DHS funding cut for counseling, etc meth production in area funding cuts statewide Family Support Strengths parent coalition gets info to parents hospitals more connected & able to share info/records schools more connected thru electronic info single application for childcare areas Problems Families not aware of what is available the “run around” of application process families are smaller & extended family does not live near each other head start waiting list Opportunities Head start DPIL Facebook pages for GSC, etc increase in available parenting classes Threats lack of financial support for programs decrease in funding for DHS, Mental health, any service agency social stigma Childcare & Early Education Strengths more qualified providers-new star rating collaboration between providers gives kids structure, purpose, direction, excitement Opportunities earlier education, better for kids socialization for single or younger kids earlier observation to potentially identify problems, delays, etc educating families on the importance of higher (more qualified/trained) childcare 40 Problems potential loss of qualified providers-New star rating teachers parental fear, trust, confidence provider cost lack of resource knowledge and/or cost for resources parental lack of knowledge/confidence in being their child’s first teacher funding for preschool physical facility availability Threats Funding cost, availability, time for provider training and continued certification Appendix C Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D Appendix D 2011 – 2012 Comprehensive Community Needs Assessment EightCAP, Inc. 0 - 5 Head Start Programs Clinton (EHS), Gratiot, Isabella, Montcalm and Ionia Counties Michigan Appendix E I. Geographic Description of the Area EightCAP, Inc. is a community action agency designated to serve the counties of Gratiot, Ionia, Isabella, and Montcalm in the central portion of the lower peninsula of Michigan. For the purposes of Early Head Start only, Clinton County, bordering Gratiot County, is also included in the designation. This service delivery area covers about 3,000 square miles of predominantly rural countryside. Sixty-seven percent of the residents live outside of incorporated cities or villages. There are only ten incorporated cities in the geographic area with populations of 5,000 or more. Population growth has been slightly decreasing in Gratiot County, while increasing from 2.5% to 7.7% in the other four counties. The cities of St. Johns (Clinton), Ithaca (Gratiot), Ionia (Ionia), Mount Pleasant (Isabella), and Stanton (Montcalm) serve as county seats of their respective counties. Isabella County encompasses the SaginawChippewa Indian Tribe, which oversees the operation of the Soaring Eagle Casino & Resort, as well as comprehensive educational, health, and social welfare systems. Mount Pleasant is also the site of Central Michigan University, with a population of approximately 16,000 on-campus students and 10,000 off-campus students. Alma College offers liberal arts programming to over 1,500 state, national, and international youth. A satellite campus of Davenport College, also located within the area, serves about 350 students. Almost 4,000 students attend Mid-Michigan and Montcalm Community Colleges. Vocational technical schools enroll over 100 trainees annually. It should be noted that college students are considered transient in the population count due to the nature of their residence. St. Johns and surrounding cities and villages serve as suburbs for employment One interstate and two U.S. expressways travel through the area. Six major Michigan thoroughfares pass through as well. Numerous county roads, paved and gravel, allow for travel within the area. Each of the four counties has public transportation services available. However, the only cities with access to this transportation are Alma in Gratiot County, Mount Pleasant and out county on a will-call basis in Isabella County, Greenville, Sidney and Stanton in Montcalm County, and Belding and the city of Ionia in Ionia County. The western borders of Montcalm and Ionia County border Kent County, with a considerable population base and labor market due to the city of Grand Rapids. Lansing, the state capital of Michigan, is within twenty miles of southeastern Ionia County. These two large cities attract business, industry, and job seekers from our service area. The northern borders of Isabella and Montcalm counties encompass the recreational aspects of Michigan--lakes, forests, rivers, and wilderness. This area is often called "the gateway to the North." This information defines the area as rural; the map identifies counties of service. Appendix E 2011 – 2012 Updated Community Needs Assessment Gratiot County 2009 Population Percent change 2000-2008 Minority population (2000 Census) Total child population Ages 0-4 Ages 5-9 Total Live Births (2007) 41,948 Children below the poverty level Children receiving subsidized child care Children receiving FIP Children in Food Assistance Program Children insured by Medicaid/MIChild Percent of children receiving free/reduced lunch Children in Special Education (2006-2007 school year) Children receiving SSI Infants born with birth defects 0.1 % 8.5% 9,023 2,411 2,406 495 ↓ ↔ ↓ ↑ ↑ ↓ 21.7% 6.5% 3.5% 26.7% 42.2% 41.6% 18.0% 15.1% 5.0% ↑ ↓ ↓ 5.4% 13.6% 12,373 3,525 3,387 726 ↑ ↑ ↑ ↑ ↑ ↓ ↑ ↓ ↓ Isabella County 2009 Population Percent change 2000-2008 Minority population (2000 Census) Total child population Ages 0-4 Ages 5-9 Total Live Births (2007) 67,176 Children below the poverty level Children receiving subsidized child care Children receiving FIP< Children in Food Assistance Program 21.7% ↑ 5.9% ↓ 1.9% ↓ 19.7% Children insured by Medicaid/MIChild Percent of children receiving free/reduced lunch Children in Special Education (2006-2007 school year) Children receiving SSI Infants born with birth defects 36.9% 33.2% 18.8% 16.2% 5.8% ↓ ↑ Appendix E 2011 – 2012 Updated Community Needs Assessment (continued) Montcalm County 2009 Population Percent change 2000-2008 Minority population (2000 Census) Total child population Ages 0-4 Ages 5-9 Total Live Births (2007) 62,733 2.8 % 6% 15,967 4,090 4,046 842 ↑ ↔ ↑ ↑ ↓ ↓ Children below the poverty level Children receiving subsidized child care Children receiving FIP Children in Food Assistance Program Children insured by Medicaid/MIChild 25.7% 3.5% 2.5% 26.1% 44.5% ↑ ↓ ↓ Percent of children receiving free/reduced lunch Children in Special Education Children receiving SSI Infants born with birth defects 50.6% 17.0% 18.5% 5.6% ↓ 3.8% 6% 15,361 4,118 4,155 808 ↑ ↔ ↓ ↓ ↓ ↓ ↑ Ionia County 2009 Population Percent change 2000-2008 Minority population (2000 Census) Total child population Ages 0-4 Ages 5-9 Total Live Births (2007) 62,574 Children below the poverty level Children receiving subsidized child care Children receiving FIP Children in Food Assistance Program 16.6% 3.8% 2.9% 17.4% Children insured by Medicaid/MIChild Percent of children receiving free/reduced lunch Children in Special Education Children receiving SSI Infants born with birth defects 35.8% 41.4% 18.9% 10.5% 6.0% ↑ ↓ ↓ Appendix E 2011 – 2012 Updated Community Needs Assessment (continued) Clinton County 2009 Population Percent change 2000-2008 Minority population (2000 Census) Total child population Ages 0-4 Ages 5-9 Total Live Births (2007) Children below the poverty level Children receiving subsidized child care Children receiving FIP Children in Food Assistance Program Children insured by Medicaid/MIChild Percent of children receiving free/reduced lunch Children in Special Education (2006-2007 school year) Children receiving SSI Infants born with birth defects 69,893 7.7 % 3.2% 17,095 4,200 4,449↑ 784 ↑ ↔ ↓ ↑ 7.7% 2.8% 1.1% 11% 21.3% 20.2% 13.4% 5.8% 7.1% ↑ ↓ ↓ ↓ ↑ ↓ ↓ 2. General Description of Service Area The service area, on average, is 92.5% white and, of the minority population reporting, 2.6 % were Afro-American, 2.86% Hispanic or Latino, and 2.04 % other races. Although the area population has increased in four of the five counties between 2000 and 2008, most recent projected population growth rates in the area decreased, with the total population down an average of 1.5%. In particular, Montcalm County showed the highest decline at 2% while Gratiot and Isabella counties maintained in the same time period. 14,144 children, 0-4, resided in mid-Michigan in 2007; 13,994 elementary school age youngsters were recorded in 2007; 14,187 middle schoolers were noted in 2007; and 20,902 high school youth were reported in 2007. In most cases, the number of school age youngsters living in the four-county area has declined. The primary language of EightCAP’s designated service area is English. Spanish-speaking families without English as a second language are less than 1%. Translators are needed for about 2% of Head Start and Early Head Start families. School districts frequently call the Head Start program for assistance in presenting kindergarten or other information to non English parents; likewise, parents request translation services as they deal with community agencies and schools. A few families participating in the college/university partnership centers may require translation for other foreign languages, as well. Trends in adolescent well being are inconsistent, with the births to teen rate exceeding the State rate in three out of four counties; the numbers of deaths by accident, homicide, or suicide significantly decreased in three counties, while worsening in the fourth; and the percentage of Appendix E high school drop-outs split with two counties improving graduation rates and two counties’ rates plunging. Activities available to youth include 4-H; Girl Scouts/Boy Scouts; county summer recreation program; after-school events; organized weekend youth centers; America’s Promise activities, and regularly scheduled church youth groups. Between 2010 and 2050, the United States is projected to experience rapid growth in its older population. In 2050, the number of Americans aged 65 and older is projected to be 88.5 million, more than double its projected population of 40.2 million in 2010. The baby boomers are largely responsible for this increase in the older population, as they will begin crossing into this category in 2011. The aging of the population will have wide-ranging implications for the country. As the United States ages over the next several decades, its older population will become more racially and ethnically diverse. Projecting the size and structure, in terms of age, sex, race, and Hispanic origin, of the older population is important to public and private interests, both socially and economically. The projected growth of the older population in the United States will present challenges to policy makers and programs, such as Social Security and Medicare. It will also affect families, businesses, and health care providers. Likewise, Michiganders are getting older and living longer. The over 65 population represents about 12% of the state population, with a recorded increase of 12.5% from 1990 to 2000 in EightCAP’s general service area; Clinton County reflected a 15.5% increase from 1990 to 2000. About 1 in every 8 Michigan residents is currently part of the elder population, while a 6% decrease of the under 17 population occurred in the same period. Homelessness can be found in all communities—rural or urban. It is not restrictive to age, gender, ethnicity, economic status, disability or familiar status. It can happen to anyone, anytime, anyplace. Although rural homelessness is not always visible, it does indeed exist in many forms, including multiple families sharing one housing unit; families moving from one relatives’ home to another; and families using temporary housing such tents, campers or other minimal structures. The mid-Michigan counties of Clinton, Gratiot, Ionia, Isabella and Montcalm are not immune to homelessness. People living without stable and safe housing are a concern for area leaders, human service providers, and the general community. A plan of action is warranted to ensure that local resident’s basic needs of housing are met. The demographics of these rural counties pose barriers for the prevention or elimination of homelessness, including • The insufficiency of jobs and lack of a living wage; • limited economic development; • high rates of poverty; • above average rates of domestic violence; • limited public transportation; • limited or no access to transitional housing or shelters; and • the overall lack of affordable and safe housing. Grandparents as parenting adults are on the rise, estimated by the Department of Human Services to be about 10% of the 0-5 population. This may be due to births to teenage moms, births to parents with substance abuse issues, incarceration of parents, or abandonment. Grandparents raising grandchildren are increasingly frustrated by the lack of resources available to support Appendix E their surrogate responsibilities, both financial and human. The incidence of foster care placement has also raised, at the same time as the unfortunate decline in available foster care placements. The new statewide focus of implementing concurrent planning for children in the Child Welfare system is being piloted in at least two counties served by EightCAP, Inc. The understanding of general population trend indicators is essential for human resource development, educational planning, as well as future policy making. 3. Economic Features Michigan was the only state where poverty rose and incomes fell last year, according to the U.S. Census Bureau. The statistics illustrate the uniqueness of Michigan's economic swoon, and the extent to which the auto industry's downward plunge has caused a ripple effect across the state. County poverty rates were reported in 2008 as Cl/8.0%;Gr/15.2; Io/14%; Is/29.4%; and Mo/15.5%. The 2007 median income in Michigan was $47,950, down 1.2 percent or $596 from the 2006 median of $48,546 – the state's nationwide ranking slid from 24th to 27th. Michigan’s 2008 median income was $47,950, This revealed a drop of 3.6% in inflation adjusted dollars. The SAIPE/US Census Bureau estimates median incomes of the counties served by EightCAP to be: 1. Clinton County $67,000 2. Gratiot County $52,700 3. Ionia County $63,100 4. Isabella County $56,700 5. Montcalm County $52,700 meaning half of all households in mid-Michigan had incomes higher than those displayed above and half had incomes lower than this amount. Michigan has also displayed an increased rate of "extreme poverty" -- a yearly income of less than half the poverty threshold, or $10,325 for a family of four. People with incomes that low may be living in unsafe conditions; are probably are not getting enough healthy food to eat; may be living in short-term shelters; and are likely skipping dosages of medication to make ends meet. Many people are struggling harder and harder just to get by, and more vulnerable people are turning to public social support for help. In addition to the 1,376,658 people who are poor in Michigan, 1,649,567 people, an additional 16.8%, are at risk of falling into poverty. These individuals, often called low income, have family incomes that fall between the official poverty line and twice the poverty line. This leaves them dangerously close to the edge, where just one event, such as an illness or job loss, can push them into poverty. The Census Bureau reports 11 percent of Michigan residents had no health insurance coverage in 2007 -- up from 10.4 percent in 2006 and 9.1 percent at the beginning of the decade. But that Appendix E was one category in which Michigan fared better than most other states. The national average of uninsured citizens was 15.5 percent, and Michigan ranked 11th best nationally in providing health coverage. More than 18 % of Michigan residents get some type of assistance through the Michigan Department of Human Services. Although general cash assistance is declining, programs that provide food and emergency help with energy and medical bills are growing steadily. The Food Assistance Program is up 136% since December 2000. Local food pantries and agencies who offer emergency cash assistance have never seen the volume of cries for help as they are seeing in 2010. Per Capita Income - 2008 Clinton Isabella $32,760 $25,988 Gratiot Montcalm $23,398 $21,786 Ionia $24,141 Since 1969, the relative per capita income standings of Gratiot, Isabella, and Ionia counties has worsened, while the Montcalm County per capita has seriously worsened by the loss of its manufacturing base. American families today are increasingly feeling the pinch of higher energy prices, housing market uncertainty, and growing health care costs. Historically, typical families could expect to see annual increases in their earnings to help cope with financial challenges, improve their standard of living, or just save for a rainy day. These expectations of economic progress are no longer being met. In an alarming reversal of past progress, real household income for the typical family has declined over the last several years. Taken together, the increase in household incomes at the median was likely due to an increase in fulltime workers, more hours worked, and/or changes in family composition. Estimates suggest that typical families now are finding it increasingly difficult to maintain real income levels. Even with additional members seeking part or full-time work, families are still seeing little improvement in their bottom line as median earnings continue to fall. The federal poverty line has traditionally been used to measure whether families have incomes high enough to enable them to meet basic needs. Yet most researchers now agree that a "poverty line" income is not sufficient to support most working families. "Basic family budgets," individualized for communities nationwide and for type of family (e.g., one parent/one child, two parents/two children) offer a realistic measure of the income required to have a safe and decent, though basic, standard of living. The Family Budget Calculator determines the income needed for particular types of families to make ends meet. Because costs of goods and services vary across the U.S., the calculator customizes the budgets for many U.S. communities—over 400 in all. Users select from one of six family types, pick a state, and then select a community to see how much that family is likely to need for housing, food, child care, etc. The calculator also shows the percent and number of families in that state living below the family budget level. It is important to note that a basic family budget is indeed "basic." It comprises only the amounts a family needs to spend to feed, shelter, and clothe it, get to work and school, and subsist in 21st century America. Hence, it includes no savings, no restaurant meals, no funds for emergencies—not even renters' insurance to protect against fire, flood or theft. Appendix E 2009 Basic Family Budgets (Calculator) (1 Parent/3 Children Rural, Michigan) Monthly housing Monthly food Monthly child care Monthly transportation Monthly health care Monthly other necessities Monthly taxes Monthly total Annual total Percentage of all people in state living below family budget line* Number of all people in state living below family budget line* $673 $562 $706 $313 $305 $333 $83 $2,975 $35,700 22.6% 409,000 (1 Parent/1 Child Rural, Michigan) Monthly housing Monthly food Monthly child care Monthly transportation Monthly health care Monthly other necessities Monthly taxes Monthly total Annual total Percentage of all people in state living below family budget line* Number of all people in state living below family budget line* $514 $265 $467 $313 $218 $210 $92 $2,079 $24,948 22.6% 409,000 (2 Parents/2 Children Rural, Michigan) Monthly housing Monthly food Monthly child care Monthly transportation Monthly health care Monthly other necessities Monthly taxes Monthly total Annual total Percentage of all people in state living below family budget line* Number of all people in state living below family budget line* $514 $587 $586 $420 $329 $297 $85 $2,818 $33,816 22.6% 409,000 According to thehealthybelly.com, the estimated cost of raising one child, without expectation of a college Appendix E education is: Expense Start Age End Age Housing 0 18 Groceries 0 18 Food 0 18 gifts 0 18 Transportation 0 18 Clothing 0 18 Healthcare 0 18 Childcare/Education 0 18 Recreation 0 18 Sports 5 18 Social 5 18 Insurance 5 18 Miscellaneous 0 18 College 18 22 Annual Cost $ $ $ $ $ $ $ $ $ $ $ $ $ $ 4398 1525 2008 330 1695 535 735 1330 330 250 450 450 1272 12796 Cost for first year (excluding college) is $15,308.00 Total cost is $269,794.00 The above cost comparison was aimed at helping middle to high-income families plan financially to raise a child. The stark reality of these figures to a low-income or fixed-income family is devastating. The Economically Disadvantaged The economically disadvantaged population has risen since the last community assessment, leaving approximately 32,000 individuals in the four-county area living in poverty. Females are 48.4% of those in the labor force at an economic disadvantage and 70% of the welfare registrants in the twocounty area. Appendix E The average monthly FIP cash assistance grant, between $368 and $527 per month, is based on a family size of three, and represents the average amount received by a family qualifying for the TANF programs. Many families have had a portion of this grant amount offset by their wage earnings. On average, it is locally estimated that this monthly amount must cover housing ($422); food ($491); clothing, household items, and phone ($233); transportation ($266); health costs ($183); child care ($708); and taxes ($394). Payment rates have not increased since 1990, despite the fact that their purchasing power has eroded by approximately 32% since 1986. According to 2000 census estimates, 5% - 7% of the area households subsist on an annual income of less than $6,500. As an agency that helps families meet emergency needs, this fact has borne out as more and more families report no income or means of support. To further substantiate this need, the Federal Head Start program has deemed homeless families as categorically eligible to participate in the program. Unemployment Rates The February 2010, unemployment rates in the designated service area of EightCAP, Inc. included: • Gratiot – 15.2% or 2,970 registered unemployed; • Isabella – 9.7% or 3,712 registered unemployed; • Montcalm – 19% or 4,947 registered unemployed; • Ionia – 15.3% or 4,503 registered unemployed; and • Clinton – 10.3% or 3,865 registered unemployed. These figures reflect a steady increase in joblessness due to the recent downturn in the economy. The unfortunate closing of the Total Petroleum and several supply feeder plants in Gratiot County in recent years has seriously affected employment rates. Electrolux completely abandoned its workforce in Montcalm County, with a total shut down of their plant. It is estimated that as many as 8,000 jobs related to Electrolux manufacturing have been lost locally. Compounding the employment situation even further is the steady decline of American automobile production, impacting parts suppliers situated around mid-Michigan. The newest segment of the population living in poverty or near poverty is those affected by job loss due to the failing economy. Persons who lived comfortably with job security and what they thought was manageable credit debt now find themselves jobless, unemployment benefits expiring, and with no relief in sight. The State of Michigan has devoted what resources it can to assist Michigan Works! in retraining and job placement efforts, but the impact on mid-Michigan has been devastating. A competition has developed in the geographic area for skilled labor, as well as dependable, entry level employees. New employers, such as Solar Ovanics, require skill sets not readily available from unemployed laborers. This has required importing employees to fill jobs needing technical proficiency; providing little or n relief to the jobless rate. The working poor account for one-fourth of all families with children; and unfortunately employment secured by this segment of the population is low skilled, low paying, and most often benefit-less. Many families fare less well than when they received public assistance. Local area jobs are concentrated in government (including casinos), services, manufacturing, and Appendix E retail trade. A significantly higher proportion of government and retail trade jobs are available in Gratiot and Isabella counties than statewide or nationally. This same trend is expected to continue for the next 5 years. 4. Housing Home Ownership and Burdened Households Mid-Michigan is a rural area experiencing typical rural problems that are compounded by extreme joblessness and very limited community resources. A lack of safe, affordable, comfortable housing is a growing concern for low-income families as they seek employment and prepare to leave the welfare rolls. Individuals may be forced to obtain substandard mobile homes, or expensive, unsubsidized apartment housing. Consumers may also be forced to seek shelter with relatives, friends, or in housing in extremely isolated areas, compounding transportation problems and social opportunities for families. Data from the U.S. Census Bureau revealed the following breakdown of households in the EightCAP, Inc. service delivery area for 2005: Number of Available Average Mortgage Renters/Monthly Housing Units Payment per Month Rental Amount County Gratiot 15,900 $500 to $1,500 3,252/$300-$749 Ionia 23,648 $500 to $1,500 4,196/$300-$749 Isabella 28,185 $500 to $1,500 6,160/$300-$749 Montcalm 27,285 $500 to $1,500 3,817/$300-$749 Census statistics further revealed that a significant portion of households bear a high cost burden to pay for their housing (more than 30% of their gross income), or live in substandard housing. These burdened households comprise 21% of the total households in Gratiot County, 21% in Ionia County, 31% in Isabella County, and 23% in Montcalm County. The population of Central Michigan University students residing in Isabella County contributes to the substantially greater proportion of renters and burdened households. Also, Isabella County families already spending a disproportionate amount of income on housing could be put at a further disadvantage by the rising housing prices stemming from the expanded Soaring Eagle Casino and Resort. These increasing prices may also contribute to the greater proportion of renters in Isabella County as the cost of owning a home rises out of the reach of many families. Household Income and Energy Statistics The majority of homes in the four-county area are heated by natural gas, closely followed by bottled, tank, or LP gas. Many of low-income residents live in rural areas that can only be serviced by LP gas delivery; wood heat is also popular for rural homes. A relatively small segment of the population uses oil to heat their homes. Electric home and water heating is an especially expensive cost to users. In FY 2009, EightCAP, Inc. weatherized the homes of over 222 low income families in the four-county service delivery area, and will far exceed that number in Fiscal Year 2010, due to the dramatic increase in home weatherization funding through ARRA. Weatherization by EightCAP is designed to make homes more energy efficient, saving families' energy dollars and providing a warmer shelter against the harsh Michigan winters. There is still uncertainty whether additional LIHEAP funds, appropriated by Congress and directed in Michigan Department of Human Services and to Michigan Community Action Agencies will be available to provide such improvements as new heating plants, roofs, and other more costly energy-saving measures. Appendix E EightCAP has initiated a renewed energy-saving public information campaign to alert area residents to methods of reducing energy usage, thereby reducing utility costs. In prior years the classes have been moderately attended; larger and more attentive numbers of attendees are learning energy conservation and cost effectiveness in recent classes. EightCAP also prevented utility shut-offs to approximately 4,000 families in the service delivery area and served over an additional 8,000 persons with supportive community services. Paying utility bills for lowincome families who cannot be assisted by the Department of Human Services helps enable these families to stay in their homes and at their jobs, and provides a safer, more stable environment for their children. In the past three years, EightCAP, Inc. has sponsored “Walk for Warmth” efforts that have generated over $45,000 in funding to offset utility payments of area families, the elderly and residents with a disability. 5. Health Information State budget cuts have drastically reduced the health services available to pregnant women and their newborn infants. Maternal and infant programs which historically supported “at risk” prenatals and babies through local community health departments have been abandoned. Directly corresponding is the increase of inadequate prenatal care in the State of Michigan by 70%. Locally, inadequate prenatal care worsened by as much as 32%. The number of infants born with a low birth weight also increased. The number of children with completed immunizations in the State of Michigan and the EightCAP service catchment area are increasing due to heightened public information campaigns. Immunization status remains a concern, however, because of the high number of low-income working families who cannot arrange clinic visits during the daytime. Evening and weekend clinics are needed to accommodate parents. A new emphasis of both the public and private healthcare systems has heightened awareness of the complications of chickenpox if immunizations are ignored. There appears to be a battle between public health and area physicians over the pneumonia vaccination – although a series by age 5 is required, inconsistent application has clouded the validity in the eyes of the medical profession. A severe shortage of dentists who will accept Medicaid reimbursement jeopardizes the dental health of area citizens. As few as one or two dental practitioners per county accept low-income families, either uninsured or insured by Medicaid. The Oral Health Coalition of Montcalm County, included in this service area, received a Community Health grant to provide a full range of dental health services to low-income children. In the past, EightCAP, Inc. has devoted a portion of its CSBG core grant to assist in the operation of this Dental Clinic; funding reductions required that the agency could no longer make this contribution. Through negotiations, the Dental Clinic will serve Gratiot County Head Start youngsters on an emergency basis. It is a goal to seek similar funding for the entire area, but State resources for community health have been greatly reduced. State budget cuts have eliminated many programs offered by local health and mental health departments, including EPSDT screenings, insurance sponsored counseling, drug and alcohol treatment programs, fullyfunded maternal and infant support systems, etc. In many cases, third party payment, including Head Start, MSRP, or Special/General Education funding, must be sought to provide necessary services to families. Michigan will soon be taking action to balance a sagging budget; serious cuts to children’s health programs may occur. Another issue that affects the early childhood population is the reduction in the comprehensiveness of physician-completed medical exams. In many instances, blood leads, hematocrits, blood pressures, and other required screenings are not completed, negating the “red flags” of a child’s health status. Through agreements with local health departments, clinics that provide H/H and lead level testing, fluoride varnishes, and hearing and vision screenings are conducted at each Head Start and Early Head Start center, as well as playgroup and Family Fun Nights. Appendix E While head lice continue to plague area families, the Head Start program has taken a new stance on head lice, including the use of natural remedies and the non exclusion of children with head lice. Family support staff are to work closely with families considered “chronic” with head lice to bring some resolution to the infestation problem. The program is very up front with families and notifies them if a breakout of head lice occurs. This policy was approved by Policy Council and developed in conjunction with the Medical Director of the Mid-Michigan District Health and Central Michigan District Health Departments. Again, health departments have been forced to eliminate projects which once addressed the head lice problem, and lice are perceived as “pests” in the child welfare and health systems of Michigan. There is no funding available to assist in the cleanup of families homes; Head Start has been able to loan vacuum cleaners when families are lacking one; and supply families with natural remedies to kill lice and eggs in their homes. Although every state entity is encouraging families to establish a medical home within their HMO (formerly Medicaid) provider, many still utilize walk-in clinics and emergency rooms. In Michigan, payment for such services is often withheld because ER’s or clinics are not authorized to provide treatment. Local early childhood programs constantly reinforce the need to carefully select a family physician, and then follow the prescribed process for medical treatment. Much education in this area is still needed. Against a backdrop of change surrounding insurance coverage for children, the rate of uninsured children remained the same between 2000 and 2006. Nationally, 12.5% of children lack health insurance; perhaps as many as 20% of mid-Michigan youngsters are not insured. Higher income children experienced a statistically significant (2 percentage points) increase in non insured, which was concentrated among children with family incomes between 200 and 300 percent of poverty. During that same period, the number of uninsured children with family incomes above 200% of poverty rose dramatically – 600,000 nationally. Higher income children also experienced modest declines in health care access, and were more likely to be uninsured in 2006. It appears that higher-income children also experienced a reduction in employer-sponsored insurance. New Federal HHS regulations, currently being promulgated, may allow state’s greater latitude in determining eligibility for Medicaid or SCHIP. Most adults who are uninsured by a private provider through their work remain uninsured. As yet, no community solutions have been reached for this issue. The Head Start program has arranged for the Mobil Dentist to see uninsured adults in local clinics during the year, when available spots are not taken by needy children. Mental Health Community mental health is publicly-funded in Michigan, but has had to reduce the availability and level of services to low-income uninsured clients. Services to address depression, violence, substance abuse and other related issues must be delayed due to funding barriers. Ionia Intermediate School District, Gratiot County Mental Health, Catholic Social Services and EightCAP, Inc. offer services to families through grant-funded initiatives on a limited basis. For those services, familycentered practice is used as a way of working with families, both formally and informally, across service systems to enhance their capacity to care for and protect their children. It focuses on the needs and welfare of children within the context of their families and communities. Family-centered practice recognizes the strengths of family relationships and builds on these strengths to achieve optimal outcomes. Family is defined broadly to include birth, blended, kinship, and foster and adoptive families. Family-centered practice includes a range of strategies, including advocating for improved conditions for families, supporting them, stabilizing those in crisis, reunifying those who are separated, building new families, and connecting families to the resources that will sustain Appendix E 6. Children’s Behavior and Well Being As social policies implemented under devolution affect adults, it also affects children. Clearly, the behaviors, resources, and well-being of adult family members help shape each child’s environment. In turn, the family environment may ultimately affect performance in school, social and emotional adjustment, health, and other dimensions of child well-being. The latest National Survey of America’s Families (although this project has not recently been updated, it still provides a “look-see” into the human side of Michigan families) prepared a “snapshot” of America’s families, addressing two areas of concern to early childhood education advocates – children’s behavior and well being, and children’s family environment. Although it was not possible to conduct individual assessments or personal interviews with children themselves, the NSAF incorporated a limited but carefully selected set of measures to provide a picture of child well-being during this period of devolution. Based on questions that parents answered about their children, the following measures were constructed for Children’s Behavior and Well Being: Engagement in school (ages 6-17) Participation in at least one extracurricular activity in the past year (ages 6-17) Levels of behavioral and emotional problems (ages 6-17) Skipping school once or more in the past year (ages 12-17) Expulsion or suspension from school in the past year (ages 12-17) Fair or poor child health (ages 0-17) These measures tap crucial aspects of child well-being. For example, high engagement in school is associated with better school performance and postponed pregnancy (Connell, Spencer, and Aber1994;Manlove 1998). Participation in extracurricular activities has been linked to improved academic performance, reduced rates of early dropout and criminal arrest, and lower risk of school-age motherhood (Eccles and Barber 1999; Mahoney 2000; Moore et al. 1998). Behavioral and emotional problems have been associated with lower literacy scores, persistent behavior problems, and maladjustment in later development (Ferdinand et al. 1999; Baydor, Brooks-Gunn, and Furstenburg 1993) According to the National Survey of America’s Families, 42% of six to eleven-year-olds in the United States were highly engaged in school. Differences did occur by income, with as much as a five point, upward span between engaged low-income and high-income children. This gap was consistent from studies completed in 1997, despite a 4 percentage point drop among higher-income peers. Eighty-one percent of U.S. six to eleven-year-olds had engaged in one or more extracurricular activities in the previous year. Activity involvement, like school engagement, varied by income: 91% of higherincome children, as opposed to 67% of low-income children, had participated in at least one activity. While this decline may reflect behavioral changes, it also may reflect reduced access to sports, music, and arts programs for low-income children. Only six percent of 6 to 11-year-olds exhibited high levels of behavioral and emotional problems in the nation, consistent with information presented in 1997. The problems were more common, however, to low-income youngsters, at 9%, than higher-income youth at 4%. Most surveyed children, 6-11, were relatively healthy in 1999; just 4% were described as being in fair or poor health nationally. Low-income children, however, were more than three times as likely to be in less than good health than their higher-income peers. A similar trend existed for children under six. In the 13 states surveyed, state levels differed from the national average by fewer than 5 percentage points on any given measure. NSAF data specific to Michigan includes: Appendix E Indicator: Children’s Behavior & Well Being All Incomes (%) *Low-Income (%) HigherIncome (%) Children ages 6-17 highly engaged in school 41.9 33.2 46.1 Children ages 6-17 participating in extracurricular 85.1 71.7 91.7 Children ages 12-17 expelled/suspended 14.0 23.3 10.2 Children ages 12-17 skipped school 1+ 15.4 21.8 12.7 Children ages 6-11with high levels of behavioral or emotional problems 8.6 13.3 5.9 Children ages 12-17 with high levels of behavioral or emotional problems 5.8 9.1 4.5 Children’s environments are closely tied to the behaviors and well-being of the adults in their homes, and the environments in which children live affect their well-being (Child Trends 1999). Of the family environment measures in the National Survey of America’s Families, only a few indicators changed nationally, for the population as a whole. There has been little progress, it was determined, in meeting two goals of welfare reform: Both the child poverty rate (Zedlewski 2000) and the percentage of children living in single-parent families has remained constant. At the same time, parental aggravation increased slightly nationwide. Overall, the NSAF showed very similar patterns during the earlier and later studies. For both project periods, children who lived in families with low-incomes or with a single parent experienced, on average, much more disadvantaged family environments than did other children. Low-income children became less likely to live with a single parent, but other aspects of their family environments did not change. Meanwhile, among higher-income children, the prevalence of high parental aggravation rose while infrequent reading to young children increased during the study. Why might the quality of children’s family environments appear static – or even worsen – given the economy and rates of poverty and single parenthood during the period studied? Several possibilities exist: It may take more than two years for changes in the family environment measures examined to register; the measures may be sensitive only to larger changes in income, family structure, or other societal forces; and improvements in children’s family environments in one group may offset declines in others. As reported by their parents, the “snapshot” of Children’s Family Environment analyzed family environments of low-income children with those of higher income children. It also compared singleparent versus two-parent family environments. Structured measures included: Family structure (with children ages 0-17) Frequency with which parents read or tell stories to their children (w/c ages 1-5) Frequency with which parents take their children on outings (w/c ages 0-5) Parental involvement in volunteering (ages w/c 0-17) parental attendance at religious services (w/c ages 0-17) Level of parental aggravation (w/c ages 0-17) Symptoms of poor parental mental health (w/c ages 0-17) Family environments in the United States reveal that single mothers are disproportionately likely to be poor, and poverty is associated with a host of negative outcomes among children (McLoyd 1998).Appendix By theE same token, children living with two biological parents are much more likely to experience a variety of positive outcomes. In the U.S. overall, 64% of minor children lived with two biological or adoptive parents in 2000, while 8% lived in a blended family. Twenty-five percent lived with a single biological or adoptive parent, and the remaining 4% lived with other adults or alone. Higher-income families remained intact 75% of the time, compared to a rate of 47% for low-income families. Similarly, about three times as many low-income children lived with a single parent as did higher-income children. Reading or telling stories to young children can help them develop their linguistic, cognitive, and literacy skills (National Center for Education Statistics 1998). Throughout our nation in 1999, 18% of children 1 through 5, consistent with 1997 rankings, lived with parents who read or told stories to them on fewer than three days per week. This proportion was nearly twice as high for low-income as for other children: 24% versus 13%. It is interesting to note that this measure worsened by about 2 percentage points from 1997 to 1999 for higher-income families. Children living with a single parent were even more likely to be read to infrequently, about 24%. Taking young children on outings is important because it can stimulate their cognitive development (Bradley and Caldwell 1980; Bradley et al. 1988). In both 1999 and 2000, 16% of all American children, 0-5, were taken on outings to the park, grocery store, church, or a playground less frequently than two or three times a month. Twenty-two percent of low-income youngsters were taken on outings infrequently, compared with 12% of higher-income children. 20% of single parent families took infrequent outings, contrasted with 15% in two-parent families. By volunteering, parents are positive role models for their children. Nationwide, 38% of children under 18 lived with a parent who volunteered at least a few times a month, the same percentage as 1997. Twenty-seven percent of single parents volunteered regularly, while 42% of two-parent families participated. The gap between income groups: 30%/ low-income families; 43% higher-income peers. Parental religiosity has been associated with many positive child outcomes, including cognitive and social competence, avoidance of early sexual activity, adolescent social responsibility, and a reduced incidence of depression. One way to measure religiosity is to determine frequency of participation in religious activities. Nationally, 59% of all minor children lived with a parent who attended at least a few religious activities a month. 49% of children in single-parent families had a parent who attended regularly, compared to 62% in two-parent families. The percentages are 54% among low-income children and 62% among higher-income children. This measure remained constant between 1997 and 1999 in all cases. A parent who reports frequently feeling stressed or frustrated by the experience of caring for children is defined as having a high level of parental aggravation. Children of highly aggravated parents are disproportionately likely to have cognitive and socio-emotional difficulties (McGroder 2000). In 1999, nationwide, 10% of children under age 18 lived with a parent who felt highly aggravated. Children living with a single parent were more than twice as likely to have a highly aggravated parent as children living with two parents (16 versus 7 percent). Similarly, low-income children were twice as likely as other children to live with a highly aggravated parent (14 versus 7 percent). Since 1997, the proportion of U.S. children with highly aggravated parents has increased slightly but significantly, and is concentrated among children living with two parents and particularly among higher-income children with two parents. Children who have clinically depressed parents or parents reporting symptoms of depression are at risk for a variety of negative outcomes, including health, cognitive, and socio-emotional problems (Downey and Coyne 1990). The National Survey of America’s Families included a mental health scale based on parents’ responses to questions about their feelings in the past month. Results included: 9 9 9 9 16% of children under 18 had a parent who reported symptoms of poor mental health in 1999. Children living with single parents were more than twice as likely to have a parent reporting symptoms of poor mental health (27%) than two-parent families (11%). 10% of children living in families with incomes over 200% of poverty had a parent reporting symptoms of poor mental health, compared with 25% of low-income families. Appendix E There was no change between 1997 and 1999 on this measure at the national level across family structure or income groups. The NSAF revealed substantial variations in children’s environments across the 13 states studied. Data specific to Michigan includes: Indicator: Children’s Family Environment All Incomes (%) *Low-Income (%) HigherIncome (%) Children in two parent families 63.5 42.4 74.6 Children in single parent families 24.3 45.2 13.2 Children, 1-5, read/ stories less than 3X per week 12.4 15.9 10.2 Children, 0-5, taken on outings 3X month or less 18.0 25.8 13.2 Children w/parent who volunteers few times month 39.4 35.1 Children w/parent attends religious services at least a few times per month 53.8 46.8 57.6 Children with a parent who is highly aggravated 8.7 13.9 6.0 16.0 23.6 11.9 Children with parent reporting symptoms of poor mental health * (below 200% of poverty) 41.7 These findings suggest that, while the population of children living in low-income or single-parent families has diminished slightly, there have been few other significant changes in children’s environments. Despite some worsening in the environments of children in families with incomes above 200% of poverty, these higher-income children continue to be far better off on average than low-income children. Indeed, low-income children fare worse on every measure examined. Findings from the National Survey of America’s Families suggest a strong link between family structure and other aspects of children’s environments that may affect their well-being. Research indicates that family environments and parents exert an important influence on the development of children (Collins et al. 2000). Continued tracking and research will determine whether income and family structure changes will ultimately change family environments and child outcomes. Profile of “at risk” Families – 0-5 years of age The profile of an “at risk” family is changing; many must secure full-time employment with minimal or no fringe benefits. Since most must travel a distance to their jobs, maintenance and insurance of a vehicle creates a new obstacle. Quality child care weighs heavily on the minds of families. Parenting, especially for single, female, head-of-households offers challenges with fewer resources available from state protective services workers. Reductions in food stamp benefits and vendor payments to utility companies has created additional stresses for families. A typical one-parent family consists of an unemployed Mom with 2 children, at least one of which is under age 5. Mom has graduated from high school, is employable, but does not have marketable skills. She receives monthly support checks, but no monthly TANF reimbursement. Her children are insured through the Federal Medicaid program. WIC and commodity distribution supplement the monthly food E Appendix needs. Because there is no dentist who will see her children locally, their teeth have gone unattended. The closest HMO physician is 12.5 miles, which is difficult with less than dependable transportation. The two-parent family fairs slightly better with a male, full-time employed head of household.. Their three children are insured through Medicaid until the income level is exceeded, and then they will be uninsured. Mom can provide care in the home, but must faithfully follow a very limited budget, since the family income hovers around 150% to 200% of poverty. They are on the list for home energy weatherization. Transportation is accomplished through one car, and assistance provided by relatives and friends. No monthly TANF check is received. Similar medical and dental issues face this family as well. The educational level of both parents is high school completion or lower, and the prospects for job advancement are slim due to low skills. Appendix E EightCAP, Inc. Head Start County 2009-10 Needs Assessment Survey Results County: Gratiot/Ionia/Isabella/Montcalm Total surveys received: 1. Single Married Divorced Widowed Separated Total Responses 2. How many people are living in your home? 2009-10 1154 Total 414 561 100 8 60 1143 % 36% 49% 9% 1% 5% Range from 2-12 people. 3. Children's ages: 0-2 3-4 5-12 12-17 18+ Total Responses 457 1049 514 128 39 2187 21% 48% 24% 6% 2% 4. Own their home. 737 64% 5. Home is: Single dwelling Duplex Mobile Apartment Total Responses 637 45 215 213 1110 57% 4% 19% 19% Range from 2 days to 6. How long have you lived at your current address? 32 years. 7. Homes that have been Weatherized. 283 25% 8. Number of adults that are employed: At least one adult is employed full time At least one adult is employed part time Total Responses 664 245 909 73% 27% 998 45 8 83 39 1173 85% 4% 1% 7% 3% 9. Type of transportation used: Own vehicle Public transportation Car pool Neighbor/friend Other Total Responses County: Gratiot/Ionia/Isabella/Montcalm Total surveys received: 2009-10 1154 Appendix E EightCAP, Inc. Head Start County 2009-10 Needs Assessment Survey Results 10. Type of insurance: Medicaid Medicare Private CSHCS Other Total Responses Total 838 36 293 31 139 1337 % 63% 3% 22% 2% 10% 11. In the past 2 years members of household have: Had difficulty in obtaining medical services Used the emergency room Received a shut-off notice from a utility company Been homeless Been without heat Used a food bank or pantry Total Responses 143 889 560 79 128 409 2208 6% 40% 25% 4% 6% 19% 12. Have completed the following schooling: 6th grade 7-8th grade 9-10th grade 11-12th grade College Total Responses 2 10 69 571 490 1142 0% 1% 6% 50% 43% 13. Seeked employment from: Michigan Works Friends/family Newspaper want ads All of the above Total Responses 78 33 70 898 1079 7% 3% 6% 83% 14. Are in need of child care: 146 13% 11 1% 15. Other older children in need of child care after school: Appendix E VII Early Childhood Education and Child Care Availability Approximately 63,780 children 0-17 reside in the counties of Gratiot, Isabella, Montcalm, and Ionia. At least 20% of those children reside in homes with incomes below poverty guidelines. Available, free early childhood education spaces in the EightCAP service delivery area for 0-5 year-olds are as follows: Early Head Start Other 0-3 Projects Head Start Michigan School Readiness 120 140 739 553 Child care and private pay preschool slots available include: Licensed Child Care * Private Pay Preschool 5,819 428 *Licensed child care includes center and home-based care. Note that the majority of Head Start and Great Start School Readiness programs do not provide full-day care, but operate in sessions of two and a half to seven hours. Parents who need more than half-day child care must provide other arrangements for their children. Programs coordinate with child care providers whenever possible, such as in transportation arrangements. The breakdown of area FIP eligible children, 0-5, is a s follows: County 0–1 1–2 2–3 3–4 4–5 Gratiot 128 186 140 143 122 Isabella 179 215 199 169 178 Montcalm 183 191 204 179 185 Ionia 188 190 209 197 192 Michigan has awarded funding to intermediate school districts to coordinate parenting education activities for parents and care givers of children, 0-6. The future is unclear, at this point, as to the viability of Michigan’s “Great Parents – Great Start” program. Child Care Need According to the State of Michigan Family Independence Agency, there is need for additional child care slots in all the Michigan counties. Local area impact studies found that, while precise predictions of future child care demand cannot be made with the data at hand, the relatively low unemployment rate in the area and the population increase resulting from fuller employment are likely to lead to a greater demand for child care over the next few years. In addition, it should be noted that many area employees work evening or night shifts, when most licensed child care is not available. The availability of regulated child care for infants and toddlers is virtually non existent in Gratiot,Appendix E Isabella, Montcalm, and Ionia Counties. Care is generally provided by relatives, friends, or neighbors. Average monthly cost in the following counties for the care of one child is as follows: Gratiot Isabella Montcalm Ionia Program/Families $409 $604 $403 $424 % Working/Full-time or Part-time Percentage w/ “Stay-at-home” Parent Early Head Start 57% 42% 1% Head Start 65% 32% 3% Involved w/ Schooling The 2007 Kids Count data book reported that among needy families, the working poor are least likely to receive assistance with child care costs, despite the indication by the 2000census that 60% of the working poor earn less than $7 per hour, meaning that their net wage barely covers their child care costs. Child care problems are becoming increasingly difficult for recipients of public assistance who are being required to work, and employed single mothers at or near the poverty level face continuing hardships in combining work with parenting. They have reported particular concern about current child care arrangements and the most hardship in affording quality child care. 8. Educational Opportunities Michigan offers a free K-12 public school opportunity to all students; disabled children, ages 0-26 receive special education services. Schools of choice allow parents to select the educational setting they feel is most suited to their child’s needs. Early Care and Education Usage Patterns of Children from Low-Income Families Participation in early care and education settings is common for children from low-income families. More than half of children younger than 6 in low-income families are regularly left in early care and education settings. More than a third of all children in low-income families in this age group are in such settings for more than 15 hours a week. Children in low-income families are found in all types of care, including center-based arrangements, family child care, and care by relatives and non relatives in home settings. More than a third are in more than one arrangement regularly. Patterns of early care and education differ for families with higher and lower incomes. Low-income children, younger than 5, in families with employed mothers are slightly less likely to be in early care and education settings overall, and more likely to be in relative care. Higher-income counterparts are more likely to take advantage of center-based care. Child care patterns also differ by age, parental marital and work status, and race or ethnicity. The use of particular early care and education arrangements reflects access to different arrangements as well as family preferences and constraints. Some factors that play a role in type of care used include the family’s financial situation and access to child care subsidies; the employment status and schedules of parent(s); whether another parent or relative can provide care; the supply, cost, and quality of different care options available in the community or near parents’ employment; access to information about care options; the location of the care and the availability of transportation; parents’ preferences and the care they are comfortable with for the child; Appendix E and special needs of the child or children. Early care and education has become a reality for many young children in America as increasing proportions of families have working parents. At the same time, a growing body of research shows the importance of the early years for children’s future development, with some findings indicating that highquality early care and education can be particularly important for the development of children in lowincome families. In addition, the United States is investing billions in public funds to support early care and education with a particular emphasis on children in low-income families. Well-designed educational programs for young, economically disadvantaged children can clearly affect their lives for the better, both during their school years and beyond. These programs also enhance the development of other children, particularly the disabled. Economic analyses indicate that providing such programs is an excellent investment in the future of our society (Barnett and Escobar, 1987). The findings regarding effective practices in early childhood programs are congruent with those effective schooling research findings that have relevance for young children. Both bodies of literature identify the following as critical components of effective schooling: • Matching instructional resources and teaching activities to the developmental levels of the children; • Holding high expectations for all children and taking steps to insure that they will be prepared for success at their next level of education; • Making sure that activities flow from previous activities and learnings into future ones; explaining these connections to the children as part of the activity; • Previewing lessons, giving clear directions, and checking student understanding; • Allowing children plenty of opportunity for guided and independent practice with new concepts and skills; • Monitoring student activities and providing help as needed; • Communicating warmth and caring to children; • Building good continuity across grade levels and making sure teachers know where their curriculum fits into the overall school curriculum; • Allocating and making use of time in ways that meet program goals; • Providing staff development opportunities with an emphasis upon skill building; and • Engaging the involvement of parents, providing them an array of involvement opportunities, and building teachers' capacity to work effectively with parents. It is essential that our society be willing to make long-range investments in our children and in the quest for ways to improve their ability to succeed in life. Children with Disabilities The Gratiot-Isabella Regional Education Service District is designated to provide administrative and instructional resources and services to local schools so that they may continue to offer high quality Appendix E learning experiences to their communities. This function is carried out in Montcalm County by the Montcalm Area Intermediate School District and Ionia County by the Ionia Area Intermediate School District. Responsibility for services to children with disabilities is divided between local education authorities and the intermediate school districts. Approximately 7,000 children with disabilities received special education services from local and intermediate school districts in the 2006-2007 school year. The only county to experience a reduction in special education students was Isabella. The largest category of disability was specific learning disabled, followed by speech and language impaired, educable mentally impaired, physically or otherwise health impaired, emotionally impaired, trainable mentally impaired, severely multiply impaired, autistic impaired, hearing impaired, severely mentally impaired, and visually impaired. All of the preschool children were labeled pre-primary impaired. Local educational authorities (LEA’s) and ISD’s (Intermediate School Districts) provide necessary special education services for children with disabilities, as required by Michigan law. Any special accommodations required for children to fully participate in an educational program is the responsibility of the LEA/ISD; other auxiliary aids and services are negotiated with the local programs, such as Head Start, as needed. Dropping out of high school is related to a number of negative outcomes. For example, the average income of persons ages 18 through 65 who had not completed high school was roughly $20,100 in 2005. By comparison, the average income of person’s ages 18 through 65 who completed their education with a high school credential, including a General Educational Development (GED) certificate, was nearly $29,700 (U.S. Census Bureau, 2006). Dropouts are also less likely to be in the labor force than those with a high school credential or higher and are more likely to be unemployed if they are in the labor force (U.S. Department of Labor, 2006). In terms of health, dropouts older than age 24 tend to report being in worse health than adults who are not dropouts, regardless of income (U.S. Department of Education, 2004). Dropouts also make up disproportionately higher percentages of the nation’s prison and death row inmates. High school graduation statistics are generally consistent in the service area, as the Michigan Department of Education and No Child Left Behind statutes demand an increase in high school graduation rates: Gratiot Isabella Montcalm Ionia State of Michigan 83.5% 86.1% 81.2% 83.4% 83.4% Adult Education Adult education in Michigan has changed considerably in the past five years. Funding has decreased to a standard state aid amount, causing districts to reduce the programming available to adults seeking their high school diploma. Additionally, the numbers of youth who are quitting traditional school to complete their education in alternate settings are increasing; children as young as 13 can be found in alternate education programs in Michigan. Charter schools are increasingly serving the needs of educationally disadvantaged youngsters in Michigan. Often enrolling youth who make little or no progress in standard public education settings, charters are exploring new teaching and service delivery models that meet the needs of enrolled pupils. Montcalm and Mid-Michigan Community Colleges allow students to secure basic courses prior to Appendix attending university or to be granted an associates degree in a technical field. EightCAP, Inc. Head Start E assisted Montcalm Community College in setting up its Child Development Associate program, and has operated a collaborative child care program on campus since Fall, 2001. Those students seeking a fouryear degree might attend Central Michigan University or privately operated Alma College. Financial aid in the form of loans, grants or scholarships are available to offset the rising costs of further education. Head Start has held formalized community partnership agreements with the following institutions of higher education: Central Michigan University Alma College Michigan State University Montcalm Community College Grand Valley State University Employment and training programs, such as the Workforce Development Act (WDA), can facilitate trade or higher education for residents of the four-county service area. Depending on the locality, grants are received to retrain displaced workers or transition the unemployed into new vocations. It is not yet clear what opportunities new training programs might offer area residents. Work First is the Michigan program developed to reform the welfare system. Persons receiving state assistance must comply with Work First requirements, including a minimum amount of employment in the private sector or community service activities; the emphasis, however, is on employment. All EightCAP, Inc. service area Counties have been designated Project Zero sites by the Family Independence Agency. Intense efforts will occur in these counties to bottom-out the number of residents receiving welfare benefits. IX. Conclusions The geographic area served by EightCAP, Inc. is rural and predominantly farm land and light industry. Caucasians make up 88% of the population, with minorities comprising 12%. On average the population is growing at a rate of 15%. The well being of children has worsened in poverty levels. Some improvements have been seen in teen births, prenatal care and child immunizations. Family structure and environment play an important role in child outcomes. The numbers of young children with disabilities has increased, except in Isabella County; special education programs for pre-primary impaired youngsters generally cannot keep up with the demand for services. Schools of choice are increasing the options available to parents for the education of their children. State work-for-aid requirements remain constant. Retraining, in light of the loss of the manufacturing base in Michigan, is increasing at a fast pace. The need for quality, affordable child care continues to grow. Although, a high percentage of parents with infants and toddlers provide care for their children at home with either the biological mother or father. The following conclusions may be drawn from this assessment of community needs: 1. 2. 3. 4. 5. 6. A lack of quality, affordable and developmental early childhood education, including parent/child interactions, preschool experiences, and appropriate parental expectations delays the development of children; Inadequate education, including life experiences, is a barrier to self-sufficiency; Parenting and life coping skills must be enhanced for families to reach their fullest potential; A disproportionate amount of economically disadvantaged families’ incomes must be spent to heat and light their homes, leaving less money for family enrichment/learning activities; Insufficient health care retards normal growth and development of children and cripples families; Appendix E The lack of transportation prohibits families from accessing services critical to their families; and 7. Low-income residents, including welfare recipients, must receive appropriate education, employment and training services to move successfully into the work force. Goals and critical objectives addressing the barriers faced by mid-Michigan families will be carried out within this 05-year-old Head Start program. Resources Data for this needs assessment was gathered from the following sources: Annual Planning Information Report 2006, 2007, State of Michigan Annual Report, 2006, Office of Children’s Ombudsman, State of Michigan Babycenter.com, 2007 Casino Impact Study, Center for Applied Research and Rural Studies, Central Michigan University 2000 U.S. Census and Census Estimates Department of Housing and Urban Development 2007 Child Trends 2007 Economic Self-Sufficiency: A Michigan Benchmark, Michigan League of Human Services EightCAP, Inc. Head Start Family Needs Assessment Survey 2009-2010 EightCAP, Inc. Weatherization and Community Services Programs 2009-2010 Innovative Practices With Vulnerable Children and Families, 2001 Kids Count in Michigan 2007 Data Book National Survey of America’s Families 1999-2004 Appendix E Appendix F Appendix G Appendix G Appendix G Appendix G Appendix G Appendix G Appendix G Appendix G Ionia County Behavioral Risk Factor Survey Research Results from the 2010 BRFS Survey Appendix H Background and Objectives The Carl Frost Center for Social Science Research was contracted by the Ionia County Health Department to conduct a Behavioral Risk Factor Survey (BRFS) of a random sample of Ionia County residents. The Ionia County Health Department is a leader in improving the health and well-being of the community by: Protecting residents from health threats Providing healthy solutions for everyone Educating people about good health Advancing community health through the development of new policies and standards The Behavioral Risk Factor Survey is conducted periodically to collect population-based estimates of the prevalence of various behaviors, medical conditions, and preventive health care practices among Ionia County residents. BRFS results will be used by the Ionia County Health Department to assess the needs of the community it serves as well as to develop and evaluate programs that promote the health of Ionia County residents. Appendix H Carl Frost Center for Social Science Research 2 Methodology Research was conducted via a telephone survey of a random sample of Ionia County residents. A random digit dialing (RDD) sample of telephone numbers was purchased from Survey Sampling, Inc. from which the telephone numbers were drawn. A total of 810 Ionia County residents completed the survey, 537 females (66%) and 273 males (33%). The 810 households represent 3.9% of the 20,606 households in Ionia County according to the 2000 U.S. Census. The same survey that was used in 1995, 1999, and 2006 by Ionia County was used this year, with minor changes and additions. This allows to trend the measures over time and note any significant changes. Unless noted, as in the Michigan BRFS, respondents who refused to answer a question or did not know the answer to a specific questions were normally excluded from analysis, thus the base sizes vary throughout this report. Appendix H Carl Frost Center for Social Science Research 3 General Health Perceptions Appendix H Eight in ten Ionia County residents consider their general health to be good or better, with 12% reporting it as “excellent.” Still, this measure has declined substantially since 1995. Perception of Personal Health Perceptions of General Health Over Time (% Good/Very Good/Excellent) Perception of General Health in 2010 100% 90% Excellent 87% 12% 82% 82% Very Good 34% 50% Good 36% 13% Fair Poor 82% 6% (n=806) 0% 1995 (n=406) 1999 (n=411) 2006 (n=862) 2010 (n=806) Appendix H Q65: Would you say that in general your health is…? Carl Frost Center for Social Science Research 5 Health Conditions Appendix H The prevalence of conditions such as depression, abuse, neglect, and dementia have declined slightly from 2006. Yet, more than one-third (35%) of Ionia County residents have experienced depression. Health Conditions Experienced Over Time 35% Depression 32% 8% Abuse 6% Neglect 4% 2006 (n=522) 2010 (n=810) 2% Dementia 1% 1% 60% None of these 62% Appendix H Q179: Have you ever experienced any of the following in yourself? Carl Frost Center for Social Science Research 7 Blood Cholesterol, Blood Pressure, and Diabetes Appendix H Nearly all Ionia County residents have had their blood pressure checked. Nine in ten (90%) have had their cholesterol checked and this proportion has increased over the years. Prevalence of high cholesterol, diabetes, and high blood pressure have all increased steadily since 1995. Prevalence of High Cholesterol, Diabetes, and High Blood Pressure Measures Checked Over Time (% Yes) 100% 99% 99% 100% 89% 80% 99% High Cholesterol, Diabetes, and High Blood Pressure Over Time (% Prevalent) 100% High Cholesterol 90% Diabetes High B/P 78% 50% 50% 50% 34% 37% 26% 49% 43% 23% Cholesterol Checked 29% B/P Checked 12% 14% 16% 5% 0% 0% 1995 (n=406) 1999 (n=407) 2006 (n=866) 2010 (n=810) 1995 Q41: Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked? Q49 Have you ever had your blood pressure checked? Q43: Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high? Q45: Have you ever been told by a doctor, nurse, or other health professional that you have diabetes? Q51: Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure? Carl Frost Center for Social Science Research 1999 2006 2010 In 2010, 7% of women were told they had diabetes only during pregnancy. Additionally, 4% of women were told they had high blood pressure only during Appendix H pregnancy. 9 Health Behaviors Appendix H Weight Appendix H Seven in ten (70%) Ionia County residents are overweight or obese, and this hasn’t fluctuated much since 2006. The good news is that the majority of the people who are obese or overweight are attempting to lose weight. Weight Status Weight Status Over Time (Calculated Using BMI) 32% Obese Overweight Normal Underweight 35% Attempting to Lose Weight by Weight Status (2010) (% Yes) 49% Total (n=805) 35% 35% 31% 29% 2% 2006 (n=839) 1% 2010 (n=781) A. Underweight (n=8)* B. Normal (n=225) C. Overweight (n=271) D. Obese (n=274) Q55: About how much do you weigh without shoes? Q63: About how tall are you without shoes? Q59: Are you now trying to lose weight? Carl Frost Center for Social Science Research 12% 20% 51% 71% Appendix H 12 In order to lose weight, most people opt for eating fewer calories and more exercise. Between one-third and half specifically eat less fat and/or fewer carbohydrates. Actions Taken to Lose Weight Other Mentions 65% Eating Fewer Calories Eating less food, n=6 Weight Watchers/support groups, n=6 64% Engaging in Physical Activity Eat healthier foods (e.g., more fruit, more vegetables, whole grain pasta), n=3 Eat more fiber/protein, n=3 48% Eating Less Fat Surgery/gastric bypass, n=2 Diabetic diet, n=2 Stop eating sugar, n=1 Eating Fewer Carbohydrates 37% Less processed food, n=1 Less junk food, n=1 Less salt, n=1 Other Base: those trying to lose weight 7% (n=395) Appendix H Q61: To lose weight, are you…? Carl Frost Center for Social Science Research 13 Physical Activity Appendix H Three-fourths of Ionia County residents participate in aerobic exercise an average of nearly 17 times per month. Average time spent exercising is nearly an hour (54 minutes). Popular non-aerobic physical exercise includes a variety of activities such as housework, gardening, and lawn care. Participation in Physical Activity Participation in Aerobic Activities in Past Month Over Time Participation in Non-Aerobic Physical Activities in Past Month (2010) Housework Yes No 83% 82% 78% 17% 18% Yes, 88% 22% 1995 (n=406) 1999 (n=411) 2006 (n=863) 78% 22% 2010 (n=810) Average Number of Times Per Month (2010) = 16.6, (n=619) 17% Work 11% Gardening 10% Lawn care/mowing 10% Weightlifting 6% Childcare 5% Bicycling 5% Golf 3% Team Sports 2% Other Average Number of Minutes Per Activity (2010) = 54.2, (n=618) Nothing 10% 21% Q67: During the past month, did you participate in any physical activities or exercises such as walking, running, swimming, calisthenics or other aerobic activities? Q69: How many times per week or times per month did you take part in this activity during the past month? Q71: When you took part in this activity, for how many minutes or hours did you usually keep at it? Q73: What other type of physical activity gave you the next most (or any) exercise during the last month? Carl Frost Center for Social Science Research (n=682) Appendix H 15 Nutrition Appendix H The majority of Ionia County residents have 1-2 servings of vegetables per day. Residents average almost four servings per week of red meat, but this rate has dropped slightly over the years. Average Servings of Meat Per Week Servings of Vegetables Per Day 4% 8% 14% 5% 8% 10.0 17% 8.0 6.0 61% 4.2 64% 4.3 3.9 4.0 3.7 3.3 3.5 2.0 13% 2006 (n=849) 6% 2010 (n=794) Red Meat White Meat 0.0 1999 1995 2006 5 or More Servings 4 Servings No Red Meat 6% 3 Servings 1 to 2 Servings No White Meat 4% None Q75: Excluding potatoes, corn, peas, and beans, how many servings of vegetables do you usually eat per day, including fresh, frozen, canned, or juice? Q77: How many servings of red meat (that is, beef, pork, lamb) do you eat per week? Q78: How many servings of white meat (that is, chicken, turkey) do you eat per week? Carl Frost Center for Social Science Research 2010 7% 4% Appendix H 17 Dining Out Appendix H Nine in ten Ionia County residents dine out at least once a month. The average of six times per month is down slightly from 2006. Dining Out Dining Out Behavior Over Time Don’t Dine Out 1 Time Per Month 2006 (n=851) 2010 (n=810) 2 Times Per Month 3 Times Per Month 10% 10% 9% 13% 12% 14% 8% 7% 25% 4 Times Per Month 5 to 9 Times Per Month 10 or More Times Per Month Number of Times Dine Out Per Month Over Time (Mean) 26% 16% 15% 6.5 5.9 2006 (n=767) 2010 (n=730) Base=dine out at least once per month 21% 15% Appendix H Q155: How often do you dine out (at a regular or fast food restaurant) per week or month? Carl Frost Center for Social Science Research 19 Tobacco Use Appendix H In general, tobacco use has declined slightly over the last 15 years, yet this is still on par with 2006 prevalence. Cigarettes are the tobacco product of choice, by far, and those who use cigarettes smoke an average of 14 times per day. Current Tobacco Use Current Tobacco Use Over Time (% Use) Average Number of Times Per Day Tobacco Products Used in 2010 Tobacco Products Currently Use in 2010 Cigarettes 81% 14.2 (n=132) 26% 26% 21% 20% Chewing Tobacco 13% 6.7 (n=19)* 1995 (n=406) 1999 (n=411) 2006 (n=863) 2010 (n=810) Cigars 6% 7.6 (n=9)* Pipe 1% 30.0 (n=2)* (n=165) Base=tobacco users Q79: Do you currently use tobacco products? Q83: Which tobacco products do you use? Q85: On average, how many times a day do you use this (these)? Carl Frost Center for Social Science Research Appendix H 21 Current smokers generally took their first puff at age 16. The fact that most smokers (86%) began smoking before the age of 18 sheds light on how easy it is for underage teens to obtain cigarettes. Age at Which First Smoked Cigarettes Age First Smoked Cigarettes Over Time Under 10 5% 7% 10 to 11 8% 7% 12 to 13 2006 (n=160) 2010 (n=147) 12% 16% 28% 22% 14 to 15 20 to 21 22 or Older 16.1 15.7 2006 (n=160) 2010 (n=147) 19% 23% 16 to 17 18 to 19 Age First Smoked Cigarettes Over Time (Mean) 12% 12% 6% 7% 11% 7% Appendix H Q81: If you currently smoke cigarettes, how old were you the first time you smoked, even one or two puffs? Carl Frost Center for Social Science Research 22 Alcohol Consumption Appendix H Four in ten (43%) residents drank alcohol at least once in the month prior to the survey, down slightly from previous years, while 15% have never tried alcohol. Residents who drink average seven drinks per month, down one full drink from 2006. Alcohol Use Number of Days in Past Month Had at Least One Drink Over Time (Includes Those Who Don’t Drink) (Mean) Drank Alcohol at Least Once in Past Month Over Time (% Yes) 4.0 4.0 3.0 1999 (n=388) 2006 (n=856) 2010 (n=800) 3.8 49% 1995 (n=406) 50% 1999 (n=388) 46% 2006 (n=863) 43% 1995 (n=406) 2010 (n=808) Drank Alcohol in Lifetime (2010) = 85%, (n=809) Q87: Keeping in mind that your answers are completely confidential, in the past 30 days, have you drunk alcohol? Q99: Again, keeping in mind that your answers are completely confidential, in your lifetime, have you drunk alcohol? Q111: During the past month, how many days per week or per month did you drink any alcoholic beverage? Carl Frost Center for Social Science Research Number of Days in Past Month Had at Least One Drink Over Time (Only Those Who Drank) (Mean) 8.3 7.1 2006 (n=386) 2010 (n=339) Base=drank alcohol in past 30 days Appendix H 24 The number of people who binge drink has declined for the county as a whole since 1995. However, one-fourth (27%) of Ionia County residents who drink alcohol have had 5 or more drinks on at least one occasion in the past 30 days. This is down from 2006. On average, binge drinkers took part in binge drinking 4 times in the past month. Binge Drinking Had 5 or More Drinks on at Least One Occasion in Past Month Over Time (Includes Those Who Don’t Drink) (% Yes) 22% 15% 12% 1999 (n=417) 2006 (n=866) 2010 (n=810) 17% 1995 (n=406) Had 5 or More Drinks on at Least One Occasion in Past Month Over Time (Only People Who Drink) (% Yes) 33% 2006 (n=397) 27% Number of Times Drank 5 or More Drinks in Past 30 Days Over Time (Mean) 4.1 4.1 2006 (n=127) 2010 (n=92) Base=had 5 or more drinks on at least one occasion in past 30 days 2010 (n=347) Base=drank alcohol in past 30 days Q115: Considering all types of alcoholic beverages, during the past month did you have 5 or more drinks on an occasion? Q117: How many times during the past month did you have 5 or more drinks on an occasion? Carl Frost Center for Social Science Research Appendix H 25 One in ten have driven a vehicle with children as passengers within 2 hours of drinking alcohol, while twice as many (21%) have driven within 2 hours of having 5 or more drinks. Still, even more have been a passenger in a vehicle with someone drunk or high. Alcohol Consumption and Motor Vehicle Use (2010) Driven Motor Vehicle with Children as Passengers Within 2 Hours of Drinking Alcohol Driven Motor Vehicle Within 2 Hours After Drinking 5 or More Alcoholic Beverages Been a Passenger in a Vehicle with Someone Drunk or High Yes, 10% No, 79% No, 90% (n=639) (n=642) Yes, 21% No, 59% (n=789) Q121: Have you ever driven a motor vehicle with children as passengers during or within 2 hours of drinking alcohol? Q122: Have you ever driven a motor vehicle, such as a car, van, truck, or motorcycle during or within 2 hours after drinking 5 or more alcoholic beverages? Q128: Have you ever been a passenger in a vehicle with someone drunk or high? Carl Frost Center for Social Science Research Yes, 41% Appendix H 26 Other Substance Use Appendix H Use of substances other than alcohol or tobacco is quite low. Less than 5% of Ionia County residents have used other substances in the past 30 days. One-fourth (28%) have used marijuana in their lifetime. Other Substances Used (2010) 28% 8% 2% Used Marijuana Not Prescribed <1% 2% Used Inhalants/ Aerosols Not as Directed 6% 4% 2% Used Over the Counter Drugs Not as Directed Past 30 Days Used Prescription Drugs Not as Directed or Not Prescribed to You <1% 1% Used Methamphetamine Lifetime (n=810) Q88, Q92, Q95, Q96, Q97: Keeping in mind that your answers are completely confidential, in the past 30 days, have you…. Q100, Q104, Q107, Q108, Q109: Again, keeping in mind that your answers are completely confidential, in your lifetime, have you… Carl Frost Center for Social Science Research Appendix H 28 Prescription Drug Use Appendix H Prescription drug use is down slightly this year from 2006. In 2010, residents are taking an average of three prescription drugs. The majority of these are taken for something other than pain. Those taking prescription drugs average three to four a day and typically get their prescriptions from one physician. Prescription Drug Use Number of Prescription Drugs Used Over Time 20% Number of Prescription Drugs Taken for Pain, Taken Daily and Doctors Prescribing (2010) Number Taken For Pain Number Taken Daily Number of Doctors Prescribing (n=578) (n=578) (n=577) None 74% 5% NA 1 19% 21% 72% 2 4% 21% 24% 3 2% 12% 4% 4 1% 11% 1% 5 or More <1% 30% <1% MEAN 0.4 3.6 1.3 24% 8% 5 or More 4 3 2 1 None 9% 12% 9% 15% 14% 18% 15% 28% 29% 2006 (n=849) 2010 (n=794) 2010 MEAN = 2.8 2006 MEAN = 3.6 Q171: How many prescription drugs do you currently take? Q173: How many of them are for pain? Q174: How many of them are taken daily? Q177: How many different doctors are prescribing medication for you? Carl Frost Center for Social Science Research Appendix H 30 Substance Abuse Behavior and Substance Abuse Treatment Appendix H Roughly one in seventeen (6%) have received substance abuse counseling or treatment. Half of these have participated in AA and approximately one-fourth have received out-patient treatment, individual counseling, and/or group counseling. Substance Abuse Counseling/Treatment Have Received Substance Abuse Counseling/Treatment Over Time Type of Treatment Received (2010) 49% Alcoholics Anonymous (AA) 7% 6% Out-Patient 28% Individual Counseling Yes No 93% 2006 (n=857) 94% 2010 (n=810) 26% Group Counseling 23% In-Patient 21% Narcotics Anonymous (NA) Other 13% 11% (n=47) Base=received treatment for substance abuse Q123: Have you ever received counseling or treatment for a substance abuse problem? Q125: What type of treatment did you receive? Carl Frost Center for Social Science Research Appendix H 32 One in twenty have provided alcohol to someone underage. Approximately the same proportion have been arrested for a substance abuse offense. Substance Abuse Related Behavior (2010) Provided Alcohol to Someone Underage Yes, 5% Been Arrested for a Substance Abuse Offense Yes, 6% No, 94% No, 95% (n=808) Q126: Have you ever provided alcohol to anyone underage? Q127: Have you ever been arrested for a substance abuse offense? Carl Frost Center for Social Science Research (n=809) Appendix H 33 Safety Seats/Seat Belt Use Appendix H Most people personally use seat belts when driving or riding in a car and make sure children are placed in child safety seats. Both of these measures have improved substantially over time. Seatbelts and Safety Seats Frequency of Seatbelt Use Over Time 72% 77% 92% 91% 13% 6% 4% 5% 1995 (n=406) Children Placed in Child Safety Seats While Riding Over Time 88% 96% 12% 6% 2% 3% 1999 (n=407) 6% 6% 12% 2006 (n=859) 2010 (n=805) 2006 (n=525) Always Almost Always Sometimes Seldom Never Q129: How often do you use seatbelts when you drive or ride in a car? Q130: Are children less than 80 lbs always placed in a child seat in cars in which you are riding or driving? Carl Frost Center for Social Science Research 4% 2010 (n=614) Yes No Appendix H 35 Emergency Preparedness Appendix H Roughly half of area residents believe they are both prepared for an emergency in Ionia County and have a plan in place in case of an actual emergency. Disaster Preparedness Family Feels Prepared for an Emergency/Disaster Over Time 45% 43% 12% 2006 (n=863) 55% 33% Family Has Plan in Case of Emergency/Disaster Over Time 49% 51% 51% 49% 2006 (n=850) 2010 (n=799) 12% 2010 (n=810) Yes No Don’t Know Q131: Do you feel that you and your family are prepared if there were an emergency in Ionia County, such as avian flu or a terrorist attack? Q133: Do you and your family have a plan in case of emergency, such as location for family to meet, water, food, etc.? Carl Frost Center for Social Science Research Yes No Appendix H 37 Home Safety Appendix H Four in ten county residents have municipal water. Three-fourths (76%) of those who don’t have municipal water at least have their water tested. Three in ten (31%) residents have tested their home for radon, and this has increased since 2006. Home Safety Home Has Municipal Water System Over Time 41% Have Tested Drinking Water Over Time 2006 (n=845) 26% 31% 74% 69% 2006 (n=828) 2010 (n=771) 40% 76% 78% 59% Have Tested Home for Radon Over Time 60% 2010 (n=799) 22% 24% 2006 (n=487) 2010 (n=470) Base=do not have municipal water system Q161: Is your water on a municipal water system? Q163: Have you ever tested your drinking water? Q165: Have you ever tested your home for radon? Carl Frost Center for Social Science Research Yes No Appendix H 39 Dental Care Appendix H Three-fourths (77%) of Ionia County residents have visited a dentist in the past two years, although this is down from previous years. The primary barrier to having routine dental checkups is cost. Dental Care Had Dental Checkup in Past Two Years Over Time Reasons for Not Visiting the Dentist (2010) No Way to Pay for Services 50% Have Full Dentures Lack of Dentists Who Take Medicaid Yes No 82% 85% 18% 15% 1995 (n=406) 1999 (n=411) 80% 77% 20% 23% 2006 (n=864) 2010 (n=810) Did not want to go 27% 9% 5% Fear of Dental Treatment 3% Too Busy 2% Currently Switching Dentists 1% No Need to Go 1% Transportation 1% Other 2% (n=185) Base=have not had dental checkup in past two years Q35: In the past two years, have you had a routine dental checkup? Q37: What was the reason you did not got in for a routine visit? Carl Frost Center for Social Science Research Appendix H 41 Prevention and Detection Behaviors Appendix H Mammography Appendix H Nearly all females 35 years or older have had a mammogram, whereas very few females younger than 35 have had one. The number of females, age 18-34, who have had a mammogram is down substantially this year. On the positive side, the majority of women who’ve had a mammogram, had it within the past 2 years. Mammogram Experience Ever Had a Mammogram (Age 18-34) Over Time 16% 19% 23% 1995 (n=49) 1999 (n=67) 2006 (n=79) 8% 2010 (n=65) Ever Had a Mammogram (Age 35+) Over Time Time Since Last Mammogram (Age 18-34) (2010) From 1 to Less Than 2 years Ago = 100% (n=3)* *Caution small base size Time Since Last Mammogram (Age 35+) (2010) 61% Within the Past Year 86% 80% 88% 92% From 1 Year to Less Than 2 Years Ago From 2 Years to Less Than 3 Years Ago From 3 Years to Less Than 5 Years Ago 1995 (n=147) 1999 (n=139) 2006 (n=410) 2010 (n=466) Q135: A mammogram is an x-ray of each breast to look for cancer. Have you ever had a mammogram? Q137: How long has it been since you had your last mammogram? Carl Frost Center for Social Science Research 5 or More Years Ago 19% 6% 5% 10% Appendix H (n=428) 44 Breast Exams Appendix H Nearly all females have had a breast exam and the majority have had one in the past year. Clinical Breast Examination Ever Had a Clinical Breast Exam Over Time Time Since Last Breast Exam (2010) Within the Past Year 95% 95% 90% 1995 (n=196) 1999 (n=210) From 1 Year to Less Than 2 Years Ago 64% 13% 92% From 2 Years to Less Than 3 Years Ago 2006 (n=521) 2010 (n=537) From 3 Years to Less Than 5 Years Ago 8% 5% Base=females 5 or More Years Ago 10% (n=502) Q139: A clinical breast exam is when a doctor, nurse, or other health care professional feels the breast tissue for lumps. Have you ever had a clinical breast exam? Appendix H Q141: How long has it been since your last breast exam? Carl Frost Center for Social Science Research 46 Pap Tests Appendix H Nearly all females have had a Pap test in 2010 and nearly half had one in the past year. Almost all had their last Pap test as part of a routine visit. Pap Test Ever Had a Pap Test Over Time Time Since Last Pap Test (2010) Reason for Last Visit (2010) Routine Checkup, 94% Within the Past Year 98% 96% 1995 (n=195) 96% 1999 (n=209) 97% From 1 Year to Less Than 2 Years Ago From 2 Years to Less Than 3 Years Ago 2006 (n=510) 2010 (n=537) From 3 Years to Less Than 5 Years Ago 49% Check Current/Previous Problem, 6% 13% (n=517) 8% 8% Base=females 5 or More Years Ago 22% (n=509) Q145: A Pap test is a test for cancer of the cervix. Have you ever had a Pap test? Q147: How long has it been since you had your last Pap test? Q149: Ws your last Pap test done as part of a routine checkup or to check a current or previous problem? Carl Frost Center for Social Science Research Appendix H 48 Prostate Exams Appendix H Nearly two-thirds of men have had a prostate exam and the majority have had one in the past year. Clinical Prostate Examination Ever Had a Clinical Prostate Exam Over Time Time Since Last Prostate Exam (2010) Within the Past Year 61% 1995 (n=210) 61% 1999 (n=187) 66% 2006 (n=327) 59% From 1 Year to Less Than 2 Years Ago 11% From 2 Years to Less Than 3 Years Ago 11% 65% 2010 (n=272) From 3 Years to Less Than 5 Years Ago 7% Base=males 5 or More Years Ago 13% (n=174) Q151: A clinical prostate exam is when a health professional feels the prostate for lumps. Have you ever had a prostate exam? Q152: How long has it been since your last prostate exam? Carl Frost Center for Social Science Research Appendix H 50 Testicular Exams Appendix H Seven in ten men have had a testicular exam, up from previous years. Half have had one in the past year. Testicular Examination Ever Had a Testicular Exam Over Time Time Since Last Testicular Exam (2010) Within the Past Year 60% 60% 63% 71% From 1 Year to Less Than 2 Years Ago From 2 Years to Less Than 3 Years Ago 1995 (n=210) 1999 (n=187) 2006 (n=317) 2010 (n=270) From 3 Years to Less Than 5 Years Ago 50% 14% 9% 10% Base=males 5 or More Years Ago 17% (n=190) Q153: A testicular exam is when a health professional checks the testicles for signs of cancer. Have you ever had a testicular exam? Q154: How long has it been since your last testicular exam? Carl Frost Center for Social Science Research Appendix H 52 Access to Health Care Appendix H Health Care Coverage Appendix H Although nearly nine in ten (88%) residents have health coverage, this number has dropped 7% from 1995 and 5% from 2006. Health Care Coverage Over Time 95% 92% 93% 89% 5% 8% 7% 11% 1995 (n=406) 1999 (n=405) 2006 (n=864) 2010 (n=807) Yes, have health coverage No health coverage Appendix H Q29: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs (Health Maintenance Organizations), or government plans such as Medicare? Carl Frost Center for Social Science Research 55 Selection and Location of Medical Care Appendix H Transportation and Caregivers Appendix H Nearly everyone has their own transportation in Ionia County. One in five are caregivers for a family member. Transportation and Caregivers Are a Primary Care Giver for a Family Member Over Time Have Own Transportation Over Time 96% 4% 2006 (n=850) 22% 20% 78% 80% 2006 (n=847) 2010 (n=805) 95% 5% 2010 (n=810) Yes No Q167: Do you have your own transportation? Q169: Are you a primary care giver for a family member? Carl Frost Center for Social Science Research Appendix H 58 Community Perceptions Appendix H Most Important Community Problem Appendix H Ionia County residents cite jobs as the most important community problem by far, and has remained a top concern since 2006. Drugs and alcohol have been perceived as major community problems since the mid-1990s. Most Important Problem in Community Today Most Important Community Problem in 2010 Jobs 44% Drugs and Alcohol 12% Health Care 10% Education 8% Property Taxes 7% Help for the Needy 5% Streets (physical) 4% Crime (including gangs) 1995 (n=406) 1999 (n=417) 2006 (n=866 ) 2010 (n=810) Drugs/Alcohol (21%) Drugs/Alcohol (19%) Jobs (31%) Jobs (44%) Education (17%) Education (15%) Drugs/Alcohol (13%) Drugs/Alcohol (12%) Jobs (9%) Health Care (10%) Health Care (11%) Health Care (10%) Crime (8%) Crime (9%) Property Taxes (7%) Education (8%) Health Care (8%) Help for the Needy (7%) Education (7%) Property Taxes (7%) 2% Environment 1% (n=810) Top 5 Most Important Community Problems Over Time Other 4% Don’t Know 4% Appendix H Q25: What do you feel is the most important problem in your community today? Carl Frost Center for Social Science Research 61 Most Important Community Health Problem Appendix H Cancer has been consistently cited as the number one community health problem over the past 15 years. More recently, obesity and lack of health insurance have come to be viewed as major health-related problems in Ionia County. Most Important Health Problem in Community Today Most Important Community Health Problem in 2010 Top 5 Most Important Community Health Problems Over Time 19% Cancer Obesity 13% 1995 (n=406) 1999 (n=417) 2006 (n=866) 2010 (n=810) Lack of Health Insurance 13% Cancer (10%) Cancer (21%) Cancer (27%) Cancer (19%) Alcoholism (2%) Drug Abuse (3%) Obesity (12%) Obesity (13%) HIV/AIDS (1%) Lack of Health Insurance (3%) Lack of Health Insurance (12%) Lack of Health Insurance (13%) Allergies (1%) AIDS (3%) Drug Abuse (7%) Drug Abuse (7%) Heart Problems (<1%) Smoking/ tobacco use (3%) Smoking/ tobacco use (4%) Specific Diseases (3%) Drug Abuse Diseases (Diabetes, MS, dementia) 7% 3% Heart Disease 2% Smoking/tobacco use 2% Youth high risk behavior 2% Lack of overall access to healthcare 2% Harm caused by environmental damage 2% Other Don’t Know (n=810) 10% 27% Appendix H Q27: What do you feel is the most important HEALTH problem in your community today? Carl Frost Center for Social Science Research 63 Health Department Services Appendix H When Ionia County residents think of their local health department, immunizations come first to mind. Other services for which the ICHD is known are the WIC program, family planning, prenatal services, mental health/substance abuse counseling, and health screenings. Services Identified By Local Health Departments Services Identified By Local Health Department (2010) 33% Immunizations WIC 13% Family Planning 9% Mental Health/Substance Abuse Counseling 5% Prenatal Services 4% Well Water Safety Issues 4% Health Screening (e.g., cancer, cholesterol) Disease Prevention Education Classes 1995 (n=298) 1999 (n=279) 2006 (n=550) 2010 (n=407) Immunizations (58%) Immunizations (64%) Immunizations (50%) Immunizations (65%) Family Planning (7%) WIC (7%) WIC (11%) WIC (18%) WIC (5%) Prenatal Services (5%) Health Screenings (9%) Family Planning (13%) Well Water Safety (4%) Family Planning (5%) Family Planning (9%) Mental Health/ Substance Abuse Counseling (8%) Prenatal Services (4%) Health Screenings (3%) Prenatal Services (6%) Prenatal Services (6%) 4% 4% Well-Baby Services 3% General Health/ Medical Services 3% Septic Systems Inspection 2% Restaurant Inspections 2% Environmental Issues Top 5 Services Identified By Local Health Departments Over Time* (n=810) 2% Note: responses less than 2% not shown *Since proportions in 1995 and 1999 excluded those who said “don’t know,” proportions in this table for 2006 and 2010 were recomputed on the lesser base, removing those who said “don’t know.” Appendix H Q181: There is a local health department in every county in Michigan that provides a number of services. Please name a service provided by your local health department. Carl Frost Center for Social Science Research 65 Services Received From County Agencies Appendix H The majority (54%) of Ionia County residents have not utilized any area agencies or their services. The agency used most often is the County Health Department, followed by the Department of Human Services. Ionia County Agencies Used Top 5 Agencies Used Over Time Agencies Used (2010) Ionia County Health Department 20% Department of Human Services (FIA) Ionia County Community Mental Health Ionia County Commission on Aging 11% 6% 6% Planned Parenthood/ Family Planning 2% Ionia Area Hospice 2% Other None 2006 (n=886) 2010 (n=810) ICHD (17%) ICHD (20%) DHS (6%) DHS (11%) ICCA (6%) ICCMH (6%) ICCMH (4%) ICCA (6%) Ionia Area Hospice (2%) Family Planning (2%) 7% (n=811) 54% Appendix H Q183: What agencies within Ionia County have you received services from? Carl Frost Center for Social Science Research 67 Reasons For Service Non-Use and Services Desired Appendix H Half of Ionia County residents report they don’t need services. However, most of those who could use services cannot think of a reason why they don’t use them. Among issues cited as deterrents are cost, lack of awareness, poor reputation, transportation, and pride. Reasons for Not Using Ionia County Services in 2010 No Need for Services 49% Cost 2% Not Aware of Services 2% Poor Reputation 2% Do Not Qualify 2% Visit Personal Physician 2% Transportation 1% Too Proud 1% Don’t Know Where to Go/Who to Ask 1% Too Far/Inconvenient/Hard to Find 1% Don’t Know/Not Sure/Nothing 40% (n=811) Appendix H Q185: What has deterred you from seeking services within the county? Carl Frost Center for Social Science Research 69 The vast majority (72%) of Ionia County residents did not volunteer a desired county service. Affordable health care was cited most often and most of the other mentions include services that already exist. Services Desired in Ionia County in 2010 Desired Services (Based on Total Sample) Affordable Healthcare/ Free Clinic Help for the Needy Desired Services (Based on Valid Responses) Affordable Healthcare/ Free Clinic 10% 6% 37% Help for the Needy 22% Mental Health/Substance Abuse Treatment and Counseling Services 2% Mental Health/Substance Abuse Treatment and Counseling Services 8% More/Better Doctors and Hospitals 2% More/Better Doctors and Hospitals 7% Public Transportation 2% Public Transportation 7% Youth Services 6% Youth Services Recycling/Affordable Trash Pickup More Information on Existing County Services Other 2% 1% Recycling/Affordable Trash Pickup 1% More Information on Existing County Services 2% No response 72% Other 4% 2% 7% (n=810) Appendix H Q187: What services, if any, would you like to see offered within the county? Carl Frost Center for Social Science Research 70 Sexual Practices and Attitudes Related to HIV/AIDS Appendix H Perception of Personal Risk for HIV/AIDS Appendix H Over the past 15 years, Ionia County residents have become increasingly more confident that their risk of contracting HIV is low. In 2010, nearly eight in ten (79%) report they have no chance of contracting the virus and this remains largely unchanged over the past year. Risk of HIV Infection Perceived Chance of Contracting HIV/AIDS Virus 59% 64% Chances of Contracting HIV/AIDS in Past Year 8% 5% 4% 5% 87% 89% 93% 94% 5% 6% 3% 72% 79% None Low Medium High 35% 31% 25% 18% 5% 4% 3% 2% 1995 (n=394) 1999 (n=407) 2006 (n=849) 2010 (n=801) 1995 (n=406) Q189: What are your chances of getting the HIV/AIDS virus? Would you say…? Q191: In the past year, have your chances of getting the HIV/AIDS virus increased, decreased, or stayed the same? Carl Frost Center for Social Science Research 1999 (n=402) 2006 (n=842) Decreased Stayed the same Increased 1% 2010 (n=789) Appendix H 73 Sexual Behavior Appendix H The number of people being tested for HIV/AIDS has increased notably since 1995, with 53% reporting in 2010 that they have been tested. The majority of Ionia County residents had one sexual partner over the past year. HIV/AIDS Tests and Number of Sexual Partners Had an HIV/AIDS Test in the Past Over Time (% Yes) Number of Sexual Partners in Past Year Over Time 4% 34% 1995 (n=388) 46% 47% 1999 (n=383) 2006 (n=834) 53% 2 or More 1 None 2010 (n=778) 75% 21% 2006 (n=835) MEAN = .95 Q193: Have you ever been tested for HIV/AIDS? Include blood donations after 1985, and include saliva tests. Q195: How many sex partners did you have in the past year? Carl Frost Center for Social Science Research 4% 69% 28% 2010 (n=787) MEAN = .88 Appendix H 75 Most people never use a condom, but then again, most have only one sexual partner. People with two or more partners are significantly more likely to use a condom than people with only one partner. Condom Use During Sexual Intercourse Frequency of Condom Use by Marital Status and Number of Sexual Partners (2010) Frequency of Condom Use Over Time 8% 2% 1% 2% 6% Number of Sexual Partners in Past Year 2% 2% C. One (n=526) E. Two or More (n=28)* Always 4% 50% Most of the time 1% 18% Some of the time 2% 0% Rarely 3% 14% Never 90% 18% 4% 87% 86% 2006 (n=849) 2010 (n=557) Always Most of the time Some of the time Rarely Never Appendix H Q197: How often do you (or your partner) use a condom during sexual intercourse?. Carl Frost Center for Social Science Research 76 On average, Ionia County residents are almost 18 years old when they have their first sexual experience. Those who are victims of sexual assault have their first sexual experience two years earlier than those who aren’t victims. Nearly one in five (18%) are victims of sexual assault. Age of First Sexual Experience and Sexual Assault Victim of Sexual Assault (2010) Age at First Sexual Experience Over Time (Mean) No, 82% 17.8 17.7 2006 (n=733) 2010 (n=722) Yes, 18% Age at First Sexual Experience (Mean) A. Experienced Sexual Assault = 16.1 B. No Sexual Assault = 18.1 Q199: How old were you when you had your first sexual experience? Q201: Have you ever been the victim of a sexual assault? Carl Frost Center for Social Science Research Appendix H 77 Attitudes Concerning HIV/AIDS Appendix H Ionia County residents are fairly tolerant of those diagnosed with HIV/AIDS. Additionally, they are more likely to encourage teenagers to use condoms today than they were fifteen years ago. Attitudes About HIV/AIDS Willing to Work Next to/Near Someone with HIV/AIDS Over Time (%Yes) 78% 1995 (n=404) 85% 1999 (n=408) 79% 2006 (n=847) Encourage Teenagers to Use Condoms Over Time (%Yes) 87% 74% 2010 (n=728) Q203: Would you be willing to work next to or near a person who is infected with the HIV/AIDS virus? Q207: If you had a teenager who was sexually active, would you encourage him or her to use a condom? Carl Frost Center for Social Science Research 1995 (n=395) 78% 1999 (n=399) 85% 89% 2006 (n=831) 2010 (n=775) Appendix H 79 REPORT 2012 Evaluation of the Great Start Initiative Customized Feedback Report Ionia GSC/GSPC Prepared by Dr. Pennie Foster-Fishman and the System exChange Evaluation Team Michigan State University www.thesystemexchange.org 1 Appendix I For More Information Contact: Pennie Foster-Fishman, Ph.D. and the System exChange Team 316 Physics Road Department of Psychology Michigan State University East Lansing, MI 48824 [email protected] or toll free at 1-866-343-5279 www.thesystemexchange.org Acknowledgements This evaluation would not have been possible without the support and hard work of: The financial support of the W.K. Kellogg Foundation Great Start Collaborative Directors and Great Start Parent Coalition Parent Liaisons Early Childhood Investment Corporation Staff GSC/GSPC members Office of Survey Research, IPPSR The System exChange Team Members Morgan Bolen I-Chien Chen Monica Fischer Sarah Harfst Sara Hockin Katie Irey Kathryn McAlindon Jenny Mortensen David Reyes-Gastelum Kelly Warsinske Abby Wattenberg Mei You Appendix I Great Start Initiative Evaluation Executive Summary Ionia GSC/GSPC 2012 The goal of the 2012 Great Start Evaluation was to assess the impact of the Great Start initiative at the State and Local levels, paying particular attention to gains made since the 2010 evaluation. Key statewide findings include: Compared to 2010, GSCs and GSPCs in 2012 made significantly more progress in building the systems changes needed to ensure that all children are ready for school. On every outcome area examined, GSCs/GSPCs accomplished far more in 2012 than they did in 2010. Of course GSCs/GSPCs varied in their achievement levels, but in general the trend across the state is positive movement forward. GSCs and GSPCs also significantly strengthened all 8 levers for change and these levers continue to play an important role in 2012. GSCs/GSPCs grew the most between 2010 and 2012 when they built authentic voice, local readiness for change, and actively pursued systems change. Three NEW levers for change have been identified: Local Champions, Root Cause Focus, and Equity Orientation and these levers were related to accomplishment levels in 2012. GSC and GSPC infrastructure also mattered, particularly the extent to which they created a continuous learning environment. BOTH the GSC and the GSPC continue to matter! The gap between older and newer collaboratives has significantly diminished. This summary report focuses on your GSC/GSPC’s: 1. Accomplishments: Outcomes which show progress toward an improved and expanded early childhood system. 2. Levers: key change strategies which are directly related to the success of Great Start efforts. 3. Stage of Promoting Change: level of performance on five core accomplishment areas. 2012 GSC/GSPC Participation - Ionia: 49 surveys were sent out to a list of GSC/GSPC Members and Community Partners provided by the GSC Director and Parent Liaison. Your GSC Response Rate was 65% and GSPC Response Rate was 73.3%. Overall, the response rate for members and nonmembers was 67.3%. Statewide, 3106 surveys were sent out, with an overall response rate of 78%. 2 Appendix I Overview Ionia 2010 2010 to 2012 Statewide 2012 2012 33.3% 60.0% 47.0% Increased Access to Early Childhood Services 35.9% 70.0% 55.1% Increased Coordination and Collaboration Across Agencies 46.2% 66.7% 63.2% Expanded Array of Early Childhood Services 32.4% 82.1% 59.3% Sustained and Expanded Public and Private Investment in Early Childhood 20.5% 63.3% 41.7% 30.8% 73.3% 60.8% 30.8% 73.3% 53.1% 28.2% 73.3% 46.7% 43.6% 66.7% 50.3% 31.6% 70.0% 43.4% 25.0% 50.0% 44.4% 0.0% 66.7% 22.0% For Parents in GSC/GSPC 41.7% 63.6% 63.7% For Organizations in GSC 4.5% 50.0% 39.5% Accomplishments: % Respondents reporting that GSC/GSPC has accomplished these impacts/outcomes Quite a Bit to a Great Deal Improved Outcomes for Children and Families Improved Early Childhood System More Responsive Community Context Comprehensive Early Childhood System Improvements Increased Community Support for Early Childhood Issues Local Providers More Responsive to Parent Concerns More Supportive Local Leaders and Elected Candidates Empowered Families as Change Agents Additional Outcomes: % respondents reporting that these conditions exist Quite a Bit to a Great Deal Parents Needs are Met Easier Access to Services Informed Parents Participation Benefits 3 Appendix I Building the Levers for Change The 2010 survey results revealed eight factors critical to promoting Great Start accomplishments. These are called the “Levers for Change.” Below is your progress in enhancing your GSC/GSPC Levers for Change. Most numbers reflect the percent of individuals responding “quite a bit” or “a great deal”. Strong Relational Networks reflects the percent of service referral/access exchanges happening between GSC member organizations. Active Constituents reflects the average level of involvement of GSC/GSPC members. Ionia GSC/GSPC Authentic Leadership and Voice Readiness for Systems Change Change Climate Levers for Change 2010 2010 to 2012 2012 Strong Relational Networks 14.8% 43.2% 0.0% 100.0% 45.5% 72.2% Individuals and organizations believe in the need for change and have the capacity 64.1% to pursue it. 86.7% Strong relational networks easily exchange referrals, coordinate services and share resources across various agencies in the community. Intentional Systems Change Actions Active pursuit of system change efforts, such as shifting or adopting new policies, procedures, or programs to reduce barriers and improve the early childhood system. Interdependent Organizations Member organizations see the value in the collaborative effort and support other partners at the table. Readiness for Change Parent Leadership & Voice Parents are effective leaders and competent champions for early childhood and represent a knowledgeable, diverse, and visible parent constituency. 42.1% 90.0% 70.6% 90.0% 55.9% 83.3% 59.1% 72.7% Effective Partnerships Strong, effective ties between the GSC and GSPC, and also with key outside organizations in the community. Engaged Constituents Shared Goals A unified vision shared with the GSC and GSPC, including: an aligned understanding of, and agreement upon problems, possible solutions, and overall goals. Active Constituents Active and involved members making valuable contributions to the GSC/GSPC, including: speaking at meetings, holding an office, or advocating for early childhood in the community. 4 Appendix I Your Great Start Effort: Moving Forward In addition to seeing how your Great Start Collaborative and Coalition has changed over time, it is also useful to look at where your GSC/GSPC is in 2012 to identify strengths and areas that need additional attention. Ionia GSC/GSPC 2012 Performance % responding Quite a Bit or a Great Deal +Strong Relational Networks: % of all possible service delivery access connections ++Active Constituents: Average level of involvement of GSC/GSPC members Use this diagram to see how you’re doing on each lever. 1. Each wedge displays your performance for a lever in 2012. 2. The colored portion of each wedge (and the number) represent the extent to which stakeholders report that your GSC/GSPC has this component. 3. Identify your strengths, successes, and opportunities for growth. Use this information to plan your next steps! Active Constituents++ Root Cause Focus (New!) Moving Forward: Your 2012 Highlights Your Strongest Areas: Effective Partnerships Strong Relational Networks+ Parent Leadership & Voice Intentional Systems Change Actions Local Champions (New!) 87% Readiness for Change Interdependent Organizations Intentional Systems Change Actions Effective Partnerships Parent Leadership and Voice Areas to Target for Improvement: Strong Relational Networks Interdependent Organizations Active Constituents 5 Appendix I Based on the 2012 evaluation, the Ionia GSC/GSPC had the characteristics of a Group C GSC/GSPC. In 2010, Ionia was a Stage 2 GSC/GSPC. 6 Appendix I About the Great Start Evaluation The primary goal of the Great Start Evaluation Project is to assess the impact of the Great Start initiative at the local and state levels. As part of this evaluation, the Great Start survey was distributed in 2010 and 2012 to members of the Great Start Parent Coalitions (GSPCs), the Great Start Collaboratives (GSCs) and other key stakeholders within their communities in order to learn more about local Great Start initiative efforts. Overall, this survey aimed to: Identify Great Start accomplishments to date and changes in accomplishments over time. Understand the GSPC and GSC characteristics related to local success. Understand what propels the GSCs/GSPCs forward toward greater accomplishments. Identify lessons learned and recommendations for next steps. The Executive Summary provides a brief overview of key findings. The full 2012 customized report contains more detailed information related to the above. About the Survey Process Sample: Great Start Directors and Parent Liaisons provided names and contact information for: GSC members, GSPC members, GSC committee members, and key outside stakeholders not yet engaged in the Great Start initiative. In 2010, a total of 3205 individuals were identified to receive the survey. In 2012, a total of 3106 individuals were identified to receive the survey. Data Collection Procedures: Between May and August 2010 and May and August 2012, identified participants were invited to participate in an online survey customized for their GSC/GSPC and their role on their respective GSC/GSPC. A mail survey version was also available. Overall Response Rates: In 2010, 2137 usable surveys were received; in 2012, 2194 usable surveys were received. In both years, some of the surveys returned could not be used (211 in 2010; 228 in 2012). Below is a table summarizing how the sample is distributed across the different survey versions in 2010 and 2012. The total response rate for 2010 was 73% (77% among GSCs and 77% among GSPCs); for 2012 it was 78% (85% among GSCs and 75% among GSPCs). 1 Appendix J Accomplishments Data was collected on each of the Great Start initiative’s outcomes, impacts, and goals for the Great Start initiative. We refer to these as Accomplishments throughout this report. Data on accomplishments was provided by GSC/GSPC members and outside community partners who assessed the extent to which the GSC/GSPC efforts that improved these conditions. The Great Start accomplishments that were measured include: Improved Outcomes for Children and Families: Outcomes for children and families are improving, specifically school readiness. Improved Early Childhood System Increased Access to Early Childhood Services: Access to early childhood services, including parents’ awareness of services, is improving. Increased Coordination and Collaboration Across Agencies: Organizations are working together efficiently, trusting each other, and being knowledgeable of one another. Expanded Array of Early Childhood Services: New or expanded programs and services for young children and their families are available. Sustained and Expanded Public and Private Investment in Early Childhood: Investment in early childhood is increasing in the community. More Responsive Community Context Comprehensive Early Childhood System Improvements: Service quality, workforce skills, and knowledge of the early childhood field are increasing. Increased Community Support for Early Childhood Issues: Public and leader support and awareness surrounding early childhood development and service delivery issues is increasing. Local Providers More Responsive to Parent Concerns: Organizations are more responsive to the needs and input of families in the community. More Supportive Local Leaders and Elected Candidates: City, county, and state elected officials are more supportive of early childhood issues. Empowered Families as Change Agents: Parents are more active in early childhood system building and effective at getting their voices heard. Additional Outcomes Parents’ Needs are Met Easier Access to Services: Parents reported the extent to which there are highquality, easy to access services that meet the needs of families in the community. Informed Parents: Parents reported the extent to which families are able to find readily-available and relevant information regarding services in the community. 2 Appendix J Participation Benefits For Parents in GSC/GSPC: Parent members assessed their involvement in the GSC/GSPC and the degree to which it has increased parenting skills, knowledge, engagement, and use of personal voice. For Organizations in the GSC: GSC service providers reported on the degree to which their involvement in the GSC has expanded partnerships, increased understanding, improved inter-organizational relationships, and increased effectiveness. Levers for Change Levers for change refer to those actions and efforts pursued by the GSCs/GSPCs to achieve their targeted outcomes and goals. Respondents were asked to describe the levers for change strategies being pursued in their community. Specific respondents were asked to describe different aspects of the Great Start effort from their perspective. The levers for change that were assessed included: Engaged Constituents Active Constituents: GSC and GSPC members described their level of involvement/participation in their local GSC/GSPC. Shared Goals: GSC and GSPC members reported the extent to which they believe their group has a shared vision and agreement on what needs to happen within the community. Parent Leadership and Voice Effective Partnerships: GSC members reported on the quality of the GSC’s partnership with the GSPC and with key outside organizations and individuals. Parent Leadership and Voice: All respondents reported on the extent to which parents are recognized as leaders and impact the GSC/GSPC and community. Readiness for Change Readiness for Change: All respondents reported the extent to which they believe that the changes promoted by the Great Start Effort are desirable, necessary, and feasible within their community. Interdependent Organizations: GSC representatives reported the extent to which their organizations are committed to the GSC, rely on other GSC organizations, and are respected by other organizations at the table. Local Champions: All respondents reported on the extent to which they have created a sense of urgency for the work within their community, have local business and government sectors committed to the Great Start effort and have local organizations aligning their organizations’ plans with the Great Start effort. 3 Appendix J Systems Change Climate Intentional Systems Change Actions: GSC Directors reported on the breadth and depth of current systems change activities. Strong Relational Networks: GSC organizational representatives described their actual exchanges of referrals, information, and resources with other GSC service providing organizations. Equitable System Pursuits Root Cause Focus: GSC and GSPC members reported on their GSC/GSPC efforts to understand and address the root or primary causes of children not being ready for school in the community. Equity Orientation: GSC and GSPC members reported on their GSC/GSPC efforts to ensure that children and families with the highest needs in the community gain access to quality programs and supports. 4 Appendix J Executive Summary – Reflection Questions Please consider these questions prior to the quarterly meetings at the end of February. What data points seem most relevant to your annual work plan? Considering your findings, what makes you most proud? What data in your findings surprised you? As you look at your survey results… what should your GSC focus on in the future? As you look at your survey results… what should your GSPC focus on in the future? Appendix K Ionia County Great Start Collaborative Strategic Planning Reviewing trends from new information & data Setting Priorities for Goals & Strategies Appendix L Updated Data Highlights Census Data: fewer children in county population, but more (higher percentage) of children are in poverty, and/or receiving a public assistance benefit indicating trouble meeting economic basic needs. (More on SNAP, TANF, MA/MI child; free or reduce cost lunch in school) TANF- Because of the high percentage of TANF families in Ionia, when TANF time limits on benefits were added by DHS and the state legislature in 2012 it had a big impact in Ionia. MLPP data ranks Ionia County with the highest percentage drop in FIP cases from 2nd 2011 to 2nd quarter 2012 of all Michigan counties (with a 48% percent drop) Appendix L Updated Data Highlights & Trends – from GSC 2012 Annual Report County has seen a decrease in teen parent population for first time in many years – with repeat teen births down by 4% County seeing a dramatic increase in number of children ages 0-5 where there is substantiated child abuse and neglect. Up from 18.25%to 25.6% in most recent reported years, and above state average of 13.8% 2.8% Increase in mothers without or only late prenatal care Percentage of WIC children reported overweight or “at risk” of being overweight is down from 2011 Appendix L Updated Health Indicator Data Health Indicators MI Percentage without Health Insurance 13.9% 14.9% 75.0% Immunization rates (age 15-35 months) Obesity in children Ionia 81.0% 11.4% 15.4% Appendix L Updated Data Highlights & Trends – from Kindergarten Round up Families Needed Help with Basic Needs - Kindergarten Round up Survey 53% 42% 39% 37% 33% 22% Ionia ISD Belding Ionia Lakewood Portland Sarnac Appendix L Updated Data Highlights & Trends – from EIGHTCap Inc. Head Start Kinds of Basic Needs Help Needed by Head Start Families at EightCAP 45% 40% 40% 35% 30% 25% 25% 19% 20% 15% 10% 5% 6% 4% 0% Appendix L Were homeless Used Food Bank/Pantry Were without heat Received Shut-off from Utility Used Emergency Room Updated Data Highlights & Trends – from Spend a Buck (Priority Setting) Child hood obesity prevention activites 16.7% Collaboration between EC service providers 8.1% Increase preschool opportunities 38.1% Parent Leadership opportunity 18.1% Basic Needs Support for 0-5 families 19.1% Appendix L Café Conversation TrendsWhat struck participants as important Categories for "Do Better On" Make System changes 13.3% Early Childhood Programming 36.7% Connections/Linkages 13.3% Health 23.3% Social/emotional 6.7% Economic 6.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% Appendix L Café Conversation TrendsWhat struck participants as important Biggest Challenges Lack of knowing resources… 26.3% Obesity 18.4% Budget cuts 18.4% Poverty growing 13.2% Lack of jobs 10.5% Abuse & Neglect 10.5% Bullying 2.6% 0.0% 5.0% Appendix L 10.0% 15.0% 20.0% 25.0% 30.0% Café Conversation TrendsWhat struck participants as important Key Factors for Improving School Readiness 34.6% Parents ready 23.1% More preschool available 23.1% Healthy children 19.2% More economic supports 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Appendix L 2012 Evaluation on Goal Progress by membership survey Strongest Areas Intentional Systems Change Actions Effective Partnership Parent Leadership Areas to Target Improvement Strong Relational Networks Interdependent Organizations Active Constituents Appendix L Current Goals in Strategic Plan 6 Goals: Establish and maintain the infrastructure of the ICGS Collaborative Birth to five children and their families are physically healthy Birth to five children and their families are socially and emotionally healthy Families support and guide the learning of their children ages birth to five Children in Ionia County are prepared to succeed in school Families of birth to five children are safe and economically stable Appendix L For each Goal’s set of Strategies What do you think is no longer a priority? What needs to be modified? Of the remaining list – what is the top priority strategy Appendix L Goal 1–Establish & Maintain the Great Start Infrastructure 1. Ensure diversity in Board membership 2. Improve engagement & effectiveness of ICGSC Board 3. Continue to support parent engagement in Board and in activities 4. Educate parents, faith based organizations and policymakers on ICGSC mission and vision 5. Increase blended funding opportunities 6. Develop coordinated message and brand 7. Coordinate advocacy messaging in Ionia County Appendix L Goal 2: Birth to 5 year old children and families are physically healthy 1. Improve public awareness on importance of breastfeeding and increase support 2. Help reduce childhood obesity through nutrition and physical activity for children and families 3. Improve oral health for young children 4. Reduce smoking during pregnancy 5. Have easy local access to prenatal care 6. Maintain immunization rates for 0-5 children 7. Have social/emotional health supports through primary care for 0-5 parents Appendix L Goal 3: Birth to age 5 children and families are socially and emotionally healthy 1. Enhance support for early childhood providers regarding social emotional health interventions for 0-5 children 2. Enhance supports for families regarding social emotional health interventions 3. Increase the availability of mental health services for families with children age 0-5 4. Maintain home visiting support for families with children age 0-5 Appendix L Goal 4: Families support and guide the learning of their children Expand the number of family support opportunities Increase opportunities for free or low cost options for families to meet basic needs Appendix L Goal 5: Children in Ionia County are prepared to succeed in school 1. Promote quality preschool experiences in county 2. Increase number of low cost or free quality preschool opportunities available to all children 3. Have universal preschool opportunities in county 4. Increase training opportunities for child care providers 5. Identify and promote common messaging on brain development and literacy readiness connections 6. Increase the number of early childhood programs with quality care for age 0-5 7. Increase preschool economic investment awareness Appendix L Goal 6: Families with children age 0-5 are safe and economically stable 1. Increase community awareness of early childhood programs and resources 2. Increase awareness and use by community partners of family friendly practices 3. Increase the knowledge and awareness by families to increase access to programs and services 4. Strengthen collaboration between referral sources 5. Support early childhood service provider collaboration Appendix L ionia Background Information (All data are for 2010 unless otherwise noted.) Number Family Support Programs Children receiving... • subsidized child care, ages 0–121 • FIP cash assistance1,3 • Food Assistance Program1,4 Children with support owed • receiving none (% of those owed) • receiving less than 70% of amount Rate MI Percent of children, ages 0-18, receiving assistance 45 246 445 4,393 2.3% 2.8% 27.3% 3.4% 6.2% 30.4% 3,939 756 2,106 23.2% 19.2% 53.5% 20.7% 29.5% 62.6% Percent of Children Medicaid 30 FAP Subsidized Care 15 0 FIP 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Source: Michigan Department of Human Services and Michigan Department of Community Health, Vital Records and Health Data Development Section. Number Rate MI Access to Health Care % 2000 2010change Population Child population 0–17 • Ages 0-4 • Ages 5-9 • Ages 10-14 • Ages 15-19 16,569 4,226 4,554 4,838 4,939 15,675 4,098 4,324 4,409 4,544 -5.4% -3.0% -5.1% -8.9% -8.0% Children insured Children, ages 0–18 insured by... • Medicaid1 • MIChild Fully immunized toddlers, ages 19–35 months (for the series 4:3:1:3:3:1)1 Lead poisoning in children, ages 1–2 • tested • poisoned (% of tested) Children, ages 1–14, hospitalized for asthma (rate per 10,000)2 14,976 94.9% 94.9% 6,307 39.2% 40.7% 214 1.3% 1.2% 944 77.8% 70.0% 658 40.5% 36.2% 4 * 0.8% 14 12.1 20.8 46 5.4% 6.6% 2,112 19.6% 14.4% 207 13.6 19.2 CHILDREN WITH SPECIAL NEEDS Babies with a birth defect** Students in Special Education1 Children receiving Supplemental Security Income (rate per 1,000)1 1As of December 2010. 2Annual rate and number are based on the three-year period 2007–2009 and only for counties with a total number over 20. 3Family Independence Program. 4State name for the federal Supplemental Nutrition Assistance Program, formerly called “food stamps.” KIDS COUNT IN MICHIGAN DATA BOOK 2011 Note: Percentages reflect percent of population unless otherwise noted. * Sometimes a rate could not be calculated because of low incidence of events or unavailable data. ** Based on three year period 2006-2008. N/A not available. See Data Notes and Definitions for details. Appendix M ionia Trends in Child Well-Being 2000–2008/09** BASE YEAR Economic Security** Children in poverty • ages 0–17 • ages 5–17 Students receiving free/reduced price school lunches2 2005 Abuse/Neglect (per 1,000) Children in investigated families Confirmed victims Children in out-of-home care Education (not proficient in math) Fourth grade (MEAP) Eighth grade (MEAP) High school students (MME) Rank1 MI Rate -100 PerCent change in rate 0 Worse 2009 100 Better Ionia Michigan 2,058 13.4% 1,330 11.8% 2006 3,068 20.7% 2,053 19.0% 2010 29 32 22.2% 20.2% 3,302 28.4% 5,117 28 46.5% Child Health 1998–2000 Less than adequate prenatal care (2008–09) ‡ — — Low-birthweight babies 49 5.9% Infant mortality (per 1,000) 5 5.6 3 25.7 Child deaths, ages 1–14 (per 100,000) Adolescence Births to teens, ages 15–19 (per 1,000) Teen deaths (per 100,000) High school dropouts** CURRENT YEAR NumberRate Number Rate 104 46.6 3 61.1 2007 95 10.3% FY2000 1,297 78.3 152 9.2 64 3.9 2003 268 33.7% 428 49.5% 2008 427 52.3% 47.6% 2007–2009 267 33.4% 53 52 6.4% 15 of 81 3 3.3 2 of 49 2 17.2 16 of 34 74 37.2 52 2 44.1 8 of 39 2010 76 8.8% 41 of 80 FY2010 1,631 107.2 389 25.6 70 4.6 2010 58 7.9% 165 21.0% 2010 363 46.1% 63 66 35 of 76 49 50 55 61 68 29.5% 8.5% 7.6 17.4 10 41 33 33.3 55.6 20 28 11.1% 70.1 13.8 5.1 14 37 178 19 2010 8.5% 22.0% 29 49.6% A ranking of 1 means a county has the ‘‘best’’ rate compared to other counties in the state. Unless noted, the ranking is based on 82–83 counties. 2 Family income for eligible students is below 185 percent poverty level. * Sometimes a rate could not be calculated because of low incidence of events or unavailable data. **Due to changes in the data measures, comparisons between 2000 and the current year could not be made for some indicators. ‡ Due to Michigan’s revised birth certificate, 2008–09 data cannot be compared with those of previous years. MME – Michigan Merit Exam instead of the MEAP. Beginning in 2007 Michigan high school students have taken the ACT college entrance exam. 1 77 58 12 Missing bars indicate no change or a rate could not be calculated; a ‘‘0’’ reflects no change. Percentage change is calculated with unrounded rates. Total Population 2009 63,905 Unemployment Rate Live Births 758 12.6% Median Household Income $46,926 Appendix M KIDS COUNT IN MICHIGAN DATA BOOK 2011 63 Kindergarten Round-up Survey Results 2012 www.GreatStartIoniaCounty.org Appendix N The Parent Coalition of the Ionia County Great Start Collaborative (ICGSC) conducted a survey with parents attending kindergarten screening activities in all of the local school districts. The purpose was to identify strengths and concerns in the areas of heath, early care and education, social-emotional development, basic physical needs and family support. The following are the results from the 2012 kindergarten screening. Parents completed a 28 item questionnaire as part of their kindergarten screening process. Within Ionia ISD, there were 955 children eligible for kindergarten, of those 511 parents or 53.5% completed the survey. Some type of preschool experience Early Care and Education: Childcare due to unemployment numbers continue to decline slightly, In 2012, sixty percent of children are reported to be in childcare at some point during their first 5 years of life due to parent employment. Families reported overwhelming satisfaction with their childcare arrangements. Preschool experiences are back on the rise from previous years. In 2012, 82% of children attended some type of preschool program. Approximately 48% were served via a government sponsored program such as Head Start (HS), Great Start Readiness Program (GSRP), and Early Childhood Special Education (ECSE). Childcare Due to Employment Health: In 2012, within the county, 96% of children have some type of health insurance. Approximately 42% have government sponsored insurance and only 1% does not have a doctor. This is good news for our community as this number is declining. Only 13% of entering kindergarteners have never been to a dentist. In 10% of homes, there is at least one person who smokes. Of the respondents, 13% reported that their child takes some kind of prescription drug. Twelve percent reported yes, they thought their child would need extra help with learning. Forty-five percent of families indicated that their child was enrolled in the Dolly Parton Imagination Library (DPIL). Enrollment continues to rise. No Health Insurance Enrolled in the DPIL program Reports of children having no health insurance continues to decline. 2 Appendix N Social Emotional: There were several questions designed to gather information regarding children’s social emotional well-being. The behaviors most frequently identified as being of concern were, children get nervous easily and children are more active than other children their age. This is consistent with previous years surveys. More Active than Other Children Child Gets Nervous Easily Basic Needs: Providing basic needs continues to be an area of concern for many families in the community. In 2012, 37% of respondents indicated that they have accessed a community support to help provide basic needs for their family. In addition, 17%, approximately 90 households, have at least one member that is on unemployment or is unemployed but has exhausted their benefits. This is lower than previous years. Someone On Unemployment Family support: Ninety-two percent of families in Ionia County indicated that they are easily able to find information about how to get their children ready for kindergarten. Approximately 45% of respondents have participated in some type of early intervention program such as: Early Head Start (EHS), Early On (EO), SHARE (Birth to 3 special education program), Great Parents, Great Start playgroups (GPGS), library programs, public health nurses or infant mental health services prior to kindergarten entry. Thirteen percent of respondents have participated in some type of parenting class or support group. Important data points in this area have remained consistent. 3 Appendix N Belding: A total of 162 children were eligible for kindergarten; 79, or 49% of parents, completed the survey. With respect to education levels, 90% of mothers and 87% of fathers had a high school diploma, GED or higher. There were 10% of mothers and 13% of fathers that had some high school but had not completed high school. Health: Forty-nine percent had some type of government funded insurance. Nineteen percent of respondents reported that their child takes a prescription medication. Four percent of respondents indicated that at least one person smoked in the home. Early Care and Education: A little more than half (56%) of respondents reported that they needed child care within the first 5 years of their child’s life. Only 8% reported that their child DID NOT have a preschool experience prior to kindergarten. Of those 8%, the number one reason was parent’s choice not to enroll. Eighteen percent of parents reported that their child would need extra help with learning. Overall, 26% of children were deferred from kindergarten for some reason and enrolled in a developmental kindergarten program. Belding respondents held the highest level of participation with sixty-six percent of participants reporting DPIL enrollment. 4 Appendix N Social Emotional: Basic Needs: Forty-two percent of respondents have used a community resource to assist with providing their children with basic needs. Sixteen percent of homes of respondents had at least one parent that was unemployed. Family Support: Fifty-seven percent of the respondents engaged in at least one outreach program prior to their child attending a preschool. Thirteen percent of respondents had visited the ICGSC website. Eleven percent had participated in some type of parent class or support group. No respondents reported participating in family counseling opportunities 5 Appendix N Ionia: A total of 273 children were eligible for kindergarten; 64, or 46% of parents, completed the survey. With respect to education levels, 86% of mothers and 83% of fathers had a high school diploma, GED or higher. There were 12% of mothers and 9% of fathers that had some high school but had not completed high school. Health: A total of 98% of children have a doctor and approximately 64% have some type of government funded insurance. Fourteen percent of respondents reported that their child takes a prescription medication. Twenty percent of respondents indicated that at least one person smoked in the home. Early Care and Education: A total of 62% of respondents reported that they needed child care within the first 5 years of their child’s life. In addition, 20% reported that their child DID NOT have a preschool experience prior to kindergarten. Of those, 40% indicated it was their choice, 44% reported that they tried to enroll in a program but it was full, and 16% indicated that they were unable to afford it. In addition, 16% of parents reported that their child would need extra help with learning. Overall, 23% of children were deferred from kindergarten for some reason and enrolled in a developmental kindergarten program. Forty-four percent of participants were enrolled in the DPIL. 6 Appendix N Social Emotional: Basic Needs: Over half (53%) of respondents reported that they have used a community resource to assist with providing basic needs to their family; 13% of homes of respondents had at least one parent that was unemployed. Family Support: Forty-three percent of the respondents engaged in at least one outreach program prior to their child attending a preschool. Eleven percent of respondents had visited the ICGSC website. Seven percent had participated in some type of parent class or support group. 7 Appendix N Lakewood: A total of 209 children were eligible for kindergarten, 117, or 56% of parents, completed the survey. With respect to education levels, 96% of mothers and 93% of fathers had a high school diploma, GED or higher. There were 4% of mothers and 4% of fathers that had some high school education but had not completed high school. Health: Ninety-nine percent of respondents reported that their child had a doctor and 33% had some type of government funded insurance. Twelve percent of respondents reported that their child takes a prescription medication. Eight percent of respondents indicated that at least one person smoked in the home. Early Care and Education: Approximately 51% of respondents reported that they needed child care within the first 5 years of their child’s life. Twenty-five percent reported that their child DID NOT have a preschool experience prior to kindergarten. Of those, 69% indicated it was their choice, 18% tried to enroll but the program was full and 14% indicated that they were unable to afford it. In addition, 15% of parents reported that their child would need extra help with learning. Overall, 20% of children were enrolled in Kinder-Start (deferred from kindergarten). Thirty-two percent of participants were enrolled in the DPIL. 8 Appendix N Social Emotional: Basic Needs: Over 30% of respondents reported that they have accessed community supports to assist with providing their family with basic needs. Seventeen percent of respondents had at least one parent that was unemployed. Family Support: Forty-seven percent of the respondents engaged in at least one outreach program prior to their child attending a preschool. Eight percent of respondents had visited the ICGSC website. Eleven percent had participated in some type of parenting class or support group. 9 Appendix N Portland: A total of 214 children were eligible for kindergarten; 144, or 67% of parents completed the survey. With respect to education levels, 94% of mothers and 94% of fathers had a high school diploma, GED or higher. There were 4% of mothers and 4% of fathers that had some high school education but had not completed high school. Health: Of those reporting, 98% indicated that their child had a doctor, and 30% had some type of government funded insurance. Sixteen percent of respondents reported that their child takes a prescription medication. Five percent of respondents indicated that at least one person smoked in the home. Early Care and Education: Sixty-nine percent of respondents reported that they needed child care within the first 5 years of their child’s life. Approximately 16% reported that their child DID NOT have a preschool experience prior to kindergarten. Of those, 74% indicated it was their choice, And 26% reported that they tried to enroll but the program was full. In addition, 6% of parents reported that their child would need extra help with learning. Overall, 32% of children were deferred from kindergarten for some reason and enrolled in a developmental kindergarten program. Forty-eight percent of participants were enrolled in the DPIL. 10 Appendix N Social Emotional: Basic Needs: Twenty-two percent of respondents reported that they have accessed a community service to help provide basic needs to their family. Nine percent of homes of respondents had at least one parent that was unemployed. Family Support: Thirty-one percent of respondents engaged in at least one outreach program prior to their child attending a preschool. Fifteen percent of respondents had visited the ICGSC Website. Eight percent had participated in some type of parent class or support group. 11 Appendix N Saranac: A total of 97 children were eligible for kindergarten; 44, or 45% of parents, completed the survey. With respect to education levels, 91% of mothers and 93% of fathers had a high school diploma. There were 9% of mothers and 7% fathers that had some high school education but had not completed high school. Health: One hundred percent of children had a doctor and about 34% had some type of government funded insurance. Approximately 14% of respondents reported that their child takes a prescription medication. Eleven percent of respondents indicated that at least one person smoked in the home. Early Care and Education: Approximately 61% of respondents reported that they needed child care within the first 5 years of their child’s life. Twenty-one percent reported their child DID NOT have a preschool experience prior to kindergarten. Of those, 50% indicated it was their choice, 20% reported they tried but the program was full and 30% indicated that they were unable to afford it. In addition, 16% of parents reported that their child would need extra help with learning. Overall, 20% of children were deferred from kindergarten for some reason and enrolled in a developmental kindergarten program. Thirty-nine percent of participants were enrolled in the DPIL. 12 Appendix N Social Emotional: Basic Needs: Thirty-nine of respondents reported that they utilized community resources to help provide basic needs for their families; 16% of homes of respondents had at least one parent that was unemployed. Family Support: Fifty-nine percent of respondents engaged in at least one outreach program prior to their child attending a preschool. Sixteen percent of respondents had visited the ICGSC website. Twenty percent had participated in some type of parent class or support group. 13 Appendix N Kindergarten Screening Parent Survey The Ionia County Great Start Collaborative (ICGSC) is a group of community members and leaders dedicated to assuring that all children are provided with a strong foundation so that they enter kindergarten eager, prepared and ready to learn. The group has several committees that focus on each of the following areas: health, early care and education, social-emotional, basic physical needs, and family support. Information from last year was complied into the Status on Young Children report. We would greatly appreciate you completing this survey so we can provide current information to the community and direct our attentions to the areas that YOU indicate would be of greatest benefit to you and your family. Thank you for your time. DEMOGRAPHIC INFORMATION: Child’s birth date: Age: Person completing form: Mother___ Father___ Other___ Parent’s Education: (check the highest level obtained) Mother: Some HS___ GED___ HS Graduate___ Tech/trade school___ 2-year degree___ BA/BS___ Masters/+ __ Father: Some HS___ GED___ HS Graduate___ Tech/trade school___ 2-year degree___ BA/BS___ Masters/+ __ Who does the child live with? Biological parents___ Mother only___ Father only___ Joint Custody (splits time equally)_____ Mother & stepfather___ Mother & significant other___ Father & stepmother___ Father & significant other___ Other extended family members (grandparents, aunts, etc.) ___ HEALTH: 1. Does your child have a doctor? 2. Has your child ever been to a dentist? 3. Currently, does your child have health insurance? Yes No Yes No ____ None, no insurance ____ Private health insurance ____ Military Health Care ____ Government Sponsored (Medicaid, Molina, MI Child, Health Plan of MI, McLaren, PHP-MM Family Care) 4. Does anyone currently smoke in the child’s home on a regular basis? 5. Does your child take any kind of prescribed medications now? If yes, for what? Yes No Yes No EARLY CARE AND EDUCATION: 6. Did your child need childcare due to your employment anytime during their first 5 years of life? If yes, were you satisfied with the childcare arrangement that you found? 7. Did your child attend a formal preschool program as a 4 or 5 year old? Yes, he/she attended: ____ Head Start ____ Great Start Readiness Program (Jump Start, Ready 4 School, D 4’s etc) ____ Early Childhood Special Education Program ____ A private preschool program __________________________________ (please indicate which one) Yes No Yes No Yes No No, my child did not attend a preschool program because: ____ It was my choice, as I did not feel he/she needed that experience prior to entering kindergarten. ____ I tried to enroll him/her in ______________________________ (name program) but it was full. ____ I was unable to afford a preschool program for him/her at this time. 8. Was your child enrolled in the Dolly Parton Imagination Library of Ionia County? 9. Do you think your child is going to need extra help with learning upon entering kindergarten? 10. How often do you read to your child? Less than 1x per week Yes 1-3x per week 14 (Continued on the back) Appendix N No Daily SOCIAL EMOTIONAL: 11. Do you think your child is going to need extra help with their behavior in kindergarten? Yes No 12. Do you think your child has a short attention span compared to other children their age? Yes No 13. Do you think your child is more active than other children his/her age? (i.e. always on the go, can’t sit still) Yes No 14. Do you think your child gets nervous easily? Yes No 15. Does your child get in fights with other children? Yes No 16. Has your child experienced a parent that is depressed? Yes No 17. Has your child witnessed violence in your home? Yes No 18. Has your child seen a family member with a drug or alcohol problem? Yes No BASIC NEEDS: 19. Yes No 20. Have you ever accessed community service (food banks, EightCap, DHS, etc) to provide necessary items for your family such as food, assistance with bills, housing, etc? Have you moved from one home to another is the past year? Yes No 21. Currently, is there anyone in your household that has lost their job and/or is on unemployment? Yes No 22. Currently, is there anyone in your household that NO LONGER qualifies for unemployment and is unable to find a job? Is there anyone in your household right now that has lost their job in the past year but is now working again for a significantly lower wage? Yes No Yes No 23. FAMILY SUPPORT: 24. Were you easily able to find information about how to get your child ready for kindergarten? 25. Did you ever participate in any of these early intervention programs with your child? ____ Home visits by a nurse from the health department, United Lifestyles, or home health agency. ____ Home visits by Early Head Start ____ Home visits by Infant Mental Health specialist from Community Mental Health ____ Home visits by Early On or the birth to three special education staff ____ Parent-child Playgroups thru Great Parents/Great Start and Early On ____ Library story-hour programs ____ (Child/family) Counseling (private or from Community Mental Health) ____ None of the above Have you ever visited the Great Start Collaborative website (GreatStartIoniaCounty.org) If yes, have you ever looked at the community calendar for events related to young children? 26. 27. No Yes No Yes No Yes No Have you ever attended any type of parenting class or support group? If yes, please explain: 28. Yes Is there anything that would have been helpful to you in getting your child off to a Great Start? 15 Appendix N 16 Appendix N Appendix O Appendix O Prepared for Sparrow Health System Sparrow Ionia Hospital: Community Health Needs Assessment Prepared by Public Policy Associates, Incorporated February 2013 Appendix P Public Policy Associates, Incorporated is a public policy research, development, and evaluation firm headquartered in Lansing, Michigan. The firm serves clients nationally in the public, private, and nonprofit sectors by conducting research, analysis, and evaluation that supports informed strategic decision making. 119 Pere Marquette Drive, Suite 1C, Lansing, MI 48912‐1231, (517) 485‐4477, Fax 485‐4488, www.publicpolicy.com Appendix P Table of Contents Executive Summary ......................................................................................................................1 Sparrow Ionia Hospital Service Area .................................................................................... 1 Key Health Care Needs Within the Sparrow Ionia Hospital Service Area ..................... 1 Priority Health Issues to Be Addressed by Sparrow Ionia Hospital ................................ 2 Introduction ...................................................................................................................................3 Purpose of this Report ............................................................................................................. 3 Data Gathering ......................................................................................................................... 3 Report Content ......................................................................................................................... 4 Sparrow Ionia Hospital Area Profile ..........................................................................................5 Community Health Indicators ..................................................................................................11 Children in Poverty ............................................................................................................... 13 Single Parent Households ..................................................................................................... 14 Housing Costs ........................................................................................................................ 15 Education ................................................................................................................................ 16 Community Safety ................................................................................................................. 17 Environmental Quality .......................................................................................................... 18 Obesity Among Adults ......................................................................................................... 19 Obesity Among Young People ............................................................................................. 20 Tobacco Use Among Adults ................................................................................................. 21 Tobacco Use Among Youth .................................................................................................. 22 Alcohol Use Among Adults ................................................................................................. 23 Alcohol Use Among Adolescents ........................................................................................ 24 Access to Physicians .............................................................................................................. 25 Preventable Hospitalizations ............................................................................................... 26 Medicaid Enrollment ............................................................................................................. 27 Health Insurance Coverage .................................................................................................. 28 Disease Prevention: Immunization ..................................................................................... 29 Mental Health (Adults) ......................................................................................................... 30 Mental Health (Youth) .......................................................................................................... 31 Perceived Health Status ........................................................................................................ 32 Infant Mortality ...................................................................................................................... 33 Low‐Weight Births ................................................................................................................. 34 Premature Deaths................................................................................................................... 35 Appendix P Cardiovascular Disease ......................................................................................................... 36 Accidental Deaths .................................................................................................................. 37 Community Health Assets .........................................................................................................39 Hospitals .................................................................................................................................. 39 Federally Qualified Health Clinics ...................................................................................... 39 Rural Health Clinics............................................................................................................... 39 Extended Care Facilities ........................................................................................................ 40 Physicians and Nurses .......................................................................................................... 40 Findings ........................................................................................................................................41 Socioeconomic Indicators ..................................................................................................... 41 Health Behaviors .................................................................................................................... 42 Access to Care ......................................................................................................................... 43 Children’s Health ................................................................................................................... 44 Health Outcomes.................................................................................................................... 45 Community Health Issues .........................................................................................................47 Methods ...................................................................................................................... Appendix A Interview and Focus Group Participants............................................................... Appendix B Appendix P Acknowledgements ____________________ This report was prepared with the assistance of Sparrow Ionia Hospital and residents throughout Ionia County who provided their time and insights in helping to identify the most important health needs, issues, and concerns throughout this region. Included among them are health care consumers, health care professionals, community leaders, government officials, working people, retirees, educators, community organization staff, and others. This assessment would not have been possible without their participation. We would also like to thank Lisa McCafferty, Director and Health Officer for the Ionia County Health Department, and Robert Lathers, CEO, Ionia County Community Mental Health, for their insights and advice for this health needs assessment. Their knowledge and experience as public health officials provided considerable insight regarding the health status and the health needs of the community served by Sparrow Ionia Hospital. Sincerely, William Roeser, CEO Dennis Swan, President and CEO Sparrow Ionia Hospital Sparrow Health System Appendix P Appendix P Assessing community health needs and adopting a strategy to address those needs provides hospitals with a valuable opportunity to work together with community partners to identify strategies for improving health, quality of life, and the community’s vitality.1 Robert Wood Johnson Foundation, 2012 1 Robert Wood Johnson Foundation, “What’s new with community benefit?” Issue Brief (October 2012), 1. http://www.rwjf.org/healthpolicy. Appendix P Appendix P Executive Summary Sparrow Ionia Hospital Service Area Sparrow Ionia Hospital serves patients throughout Ionia County, Michigan. Patients requiring more advanced services than are available at Sparrow Ionia Hospital typically seek these services in Lansing or in Grand Rapids, Michigan. The following information regarding the most important health care needs and issues within Ionia County is based on insights provided by health care consumers, community leaders, health care professionals, and others in the Sparrow Ionia Hospital service area who were interviewed as part of this assessment. These findings are also based on social, economic, and health care data about Ionia County that were drawn from federal and state government agency reports. Much of the quantitative data presented in this assessment were extracted from these sources and provided to Sparrow Health System by the Ingham County Health Department. Key Health Care Needs Within the Sparrow Ionia Hospital Service Area Healthy Life Styles. The Ionia community is characterized by high rates of overweight and obese adults and youth. Interviewees generally recognize a need to reduce obesity in children and adults within the community in order to reduce the likelihood of diabetes and other chronic diseases in the future. This is closely associated with the need to promote healthy lifestyles through better eating patterns, greater amounts of physical activity, and the reduction of “screen time” for video games and television, especially among children, as indicated by individuals who were interviewed for this report. Access to Primary Care Services. According to data provided by the Michigan Department of Community Health, Ionia County is underserved by primary care physicians and other primary care providers. One of seven community residents lacks a primary care physician. Data also show that residents of Ionia County are more likely to lack health insurance than residents elsewhere in the Sparrow Health 1 Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix P System service area, and it is believed by some interviewees that lack of insurance contributes to area residents’ lack of a primary care physician. Chronic Diseases. The impact of poor health behavior choices and the lower rate of health insurance among Ionia County households contribute towards relatively high rates of chronic diseases in the area, according to community leaders who participated in this assessment. It is widely accepted among health care professionals that high rates of obesity and depression or poor mental health are associated with chronic diseases, and these diseases (such as heart disease or diabetes) are typically reflected in relatively high levels of premature mortality (e.g., death before age 75). Lack of access to primary care services may also contribute to the lack of preventive care and ongoing monitoring that is needed to keep chronic diseases in check. Priority Health Issues to Be Addressed by Sparrow Ionia Hospital Based on the needs identified in the Healthy! Capital Counties collaborative and supplemental research conducted by Sparrow Health System, Sparrow Ionia Hospital will address the following priority health issues in an Implementation Strategy: Healthy lifestyles Access to primary care 2 Sparrow Ionia Hospital | February 2013 Appendix P Introduction ___________________________ Purpose of this Report As a community‐based hospital, the mission of Sparrow Ionia Hospital is “to improve the health of the people in our communities by providing quality, compassionate care to everyone, every time.”2 The purpose of this report is to assess the health status and health issue concerns within this community in order for Sparrow Ionia Hospital staff to identify and understand the community’s most pressing health care needs and to suggest activities and services to address these needs and concerns. The results of this assessment will provide the basis for developing a set of specific actions that Sparrow Ionia Hospital, in collaboration with other community partners, may undertake to resolve these issues and concerns and, ultimately, improve the health status of the community at large and the health of its individual residents. Although Ionia County is not part of the geographic area represented by the Healthy! Capital Counties (H!CC) Collaborative, this community health needs assessment (CHNA) was modeled on the assessment conducted by the Collaborative in the Greater Lansing area over the past eighteen months. H!CC is a consortium of hospitals and community health departments in the tri‐county Lansing area, comprising Clinton, Eaton, and Ingham Counties. Sparrow Health System is a leading participant in the H!CC Collaborative, and much of the information presented in the CHNA for the Greater Lansing area has been used to provide a relevant set of comparisons for the health indicators presented for Ionia County. This report is designed to be used by Sparrow Ionia Hospital along with public and private organizations throughout Ionia County, Michigan, as a benchmark for improving the health and well‐being of every resident of this area. Data Gathering The information presented in this CHNA has been gathered from two principal sources. 2 Sparrow Health System. Accessed December 19, 2012. http://www.sparrow.org/missionvision/. 3 Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix P Statistical information about the population of the community served by Sparrow Ionia Hospital, the social and economic characteristics of the community, and the health care experiences and characteristics of the residents of the community are derived from a variety of standard sources of information including the Centers for Disease Control and Prevention (CDC), the Michigan Department of Community Health (MDCH), and the Bureau of the Census. Much of this statistical information was provided to Sparrow Health System by the Ingham County Health Department. This statistical information has been supplemented by interviews conducted with residents of the community served by Sparrow Ionia Hospital and interviews with public health officials in Ionia County. These interviews provide balance to the statistical information provided by incorporating the insights and perceptions of the community’s residents, including their perceptions of what they believe are the most important health care issues within the community and their suggestions as to what should be done about them. Although the identities of these contributors are confidential, a list of the types of people who participated is provided in Appendix B. Report Content This assessment contains the following information: A profile of the demographic, socioeconomic, and health status characteristics of the community served by Sparrow Ionia Hospital. Twenty five one‐page community indicator reports that provide specific data for the six‐county region served by Sparrow Health System’s four community hospitals, including comparative data for the State of Michigan. These indicator pages also provide some additional details about the indicators, the sources of information, and comments about the issues that the indicator reflects that have been gleaned from interview and focus groups participants. A brief list of health resources within the Sparrow Ionia Hospital service area. Findings that identify the most important health care concerns and issues within the community based on the data presented. 4 Sparrow Ionia Hospital | February 2013 Appendix P Sparrow Ionia Hospital Area Profile______ Lansing area community residents and leaders interviewed for the Sparrow Health System Community Health Needs Assessment reported their perceptions of the health status of community residents in this region are mainly “Fair” to “Good.” Community Leadersʹ Perceived Area Health Status, 2012 (1 = Very Poor, 6 = Excellent) Six‐County Area 3.66 Sparrow Clinton 3.8 Sparrow Ionia 3.86 Sparrow Lansing 3.33 Sparrow Specialty 3.75 0 1 2 3 4 5 6 This response is in contrast to the perceptions of individuals’ own health status as reported in the 2010 Behavioral Risk Factor Survey for this area. In that study 57 percent of area residents indicated that their personal health status was excellent or very good; 16 percent reported their own health status as fair or poor. Despite these relatively healthy findings, there are considerable health care issues and health care needs evident throughout much of the Sparrow Hospital service area as revealed through the statistical profiles provided in the following pages and through the comments provided through interviews with community leaders. 5 Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix P Sparrow Ionia Hospital Profile Ionia County has a population of 63,905 residents, as reported in the 2010 Census of Population. Ionia County is the second smallest county in the six-county Sparrow Health System (SHS) service area. Although Ionia County is roughly half-way between the Lansing and Grand Rapids areas of influence, basic health care services are provided by Sparrow-Ionia Hospital while more advanced health care services are provided by hospitals in Lansing and Grand Rapids, respectively. Ionia County is characterized by a mixed economy consisting of manufacturing, agriculture, and government. The major Ionia County employer is the State of Michigan Department of Corrections. Population Characteristics – Ionia County Ionia County Population by Race 0.5% 1.3% 1.4% 4.7% 0.4% White African‐ American Asian American Indian/Alaskan Native Other 91.7% Multi‐racial • Population size: 63,905 • Age breakout: 0 – 4: 6.4% 5 – 14: 13.7% 15 – 44: 41.4% 45 – 64: 27.0% 65 – 74: 6.5% 75 and over: 4.9% • Median age: 37.0 years • Racial composition: White: 91.6% African American: 4.7% American Indian/Alaska Native: 0.5% Asian: 0.4% Multi-racial: 1.4% Other: 1.3% Native Hawaiian/Pac. Islander: None • Ethnic composition: Hispanic: 4.5% Non-Hispanic: 95.5% Source: Bureau of the Census, 2010 Census of Population 6 Sparrow Ionia Hospital | February 2013 Appendix P Social and Economic Indicators – Ionia County Indicator Definition Percentage Income Children below 18 in poverty 21.0% Family Single parent households 10.8% Education Safety Affordable Housing Environment Population age 25+ with a high school degree Population age 25+ with a Bachelor’s degree or higher Rate of violent crimes per 100,000 person Percentage of households that spend more than 30% of income on housing Population density per square mile Relationship to Michigan 86.7% 13.1% 156.6 34.5% 111.9 people per mile2 Lower Density More favorable than the statewide average About average Less favorable than the statewide average Source: Bureau of the Census, American Community Survey, 2006-2010; 2010 Census of Population; Michigan State Police, 2010. Ionia County is similar to the statewide average for several of the social and economic indicators identified above, including percentage of children living in poverty, single parent households, affordable housing (households that spend 30% or more of income on housing), and the percentage of the population that has a high school degree. Although 90% of adults age 25 or more are high school educated, only 13% of the adult population holds a bachelor’s degree; the latter percentage is considerably below the statewide average for college graduates. This figure also is impacted by the thousands of state correctional inmates housed in Ionia County, few of whom have more than a high school education. Although thousands of convicted criminals are housed in four correctional facilities in Ionia County, this is a relatively safe community with a rate of violent crimes well below the statewide average. 7 Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix P Health Indicators – Ionia County Indicator Child Health Definition Rate of preventable asthma hospitalizations per 10,000 children Results 4.3 per 10,000 Quality of Life Perceived health status as “fair” or “poor” Adult Health Rate of preventable diabetes-related hospitalizations among adults 13.6 per 10,000 Premature Deaths Percentage of deaths prior to age 75 50.6% Maternal and Child Health Safety Policies/ Practices Low birth weight and very low birth weight babies Age-adjusted death rate due to accidental injury More favorable than the statewide average About average Source: Michigan Department of Community Health, 2012. Comparison With Michigan 11.5% 65.7 per 1,000 live births 62.2 per 10,000 Less favorable than the statewide average Ionia County children exhibit substantially lower rates of preventable asthma hospitalizations—a common indicator of community health—when compared to both the state average and the six‐county service area. Similarly, Ionia County has a relatively low rate of underweight babies. The percentage of premature deaths is also lower than the state average. Only 11.5 percent of residents perceive their health status as “fair” or “poor.” Adults have similar rates of diabetes‐related hospitalizations as found throughout the state. However, the rate of accidental deaths in Ionia County exceeds the statewide average; and the rate of fatalities from automobile accidents in Ionia County in 2011 (approximately 1.2 per 10,000 residents) was higher than the expected rate across the state (approximately 0.9 fatalities per 10,000 residents). Source: Michigan Department of Transportation, 2011 Michigan Traffic Crash Facts. Lansing, MI; Michigan Office of Highway Safety Planning, 2012. 8 Sparrow Ionia Hospital | February 2013 Appendix P Behavior, Physical Condition, and Access to Care Indicators – Ionia County Indicator Definition Percentage Percentage of adults who are obese 30.7% Percentage of adolescents who are obese 18.9% Comparison With Michigan Obesity Tobacco Use Alcohol Use Access to Care Prevention Mental Health Percentage of adults who currently smoke Percentage of adolescents who smoked in the past month Percentage of adults who binge drank in past month Percentage of adolescents who binge drank in past month Percentage of residents lacking a primary care physician Percentage of population enrolled in Medicaid Ratio of population per primary care physician Percentage of children 19 to 35 months old with recommended vaccinations Percentage of adults who report their mental health is “not good” 15.4% 13.9% 15.8% 17.4% 13.4% 10.7% 2670 per physician 81.0% 14.0% More favorable than the statewide average About average Less favorable than the statewide average Source: Michigan Department of Community Health, Michigan Behavioral Risk Factor Survey, 2008-2010; Health Resources and Services Administration, Area Resource File, 2010. Prevelence of Overweight and Obese Adults in the SHS Service Area as Indicated by Body‐Mass Index (BMI) Obese Adults 90% Overweight Adults 80% 70% 60% 50% 40% 49.5% 29.3% 30.7% 25.0% 22.0% 33.9% 36.2% 32.3% 35.8% 30.1% Clinton Eaton Gratiot Ionia Ingham 24.1% 30% 20% 10% 47.6% 0% Shiawassee Source: Michigan Behavioral Risk Factor Survey, 2008-2010 9 Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix P 10 Sparrow Ionia Hospital | February 2013 Appendix P Community Health Indicators ___________ The indicators listed in Table 1, below, are presented in the following pages. They are grouped within the following categories: Social, Economic, and Environmental Indicators: Children in Poverty; Single Parent Households; Education; Community Safety; Housing Costs; Nitrate Levels in Well Water (environmental quality) Health Behavior Indicators: Adult Obesity; Youth Obesity; Adult Tobacco Usage; Youth Tobacco Usage; Adult Alcohol Consumption; Youth Alcohol Consumption Clinical Care Indicators: Access to Physicians; Preventable Hospitalizations (Ambulatory‐Sensitive Admissions); Medicaid Enrollment; Health Insurance Coverage; Childhood Immunization Mental Health Indicators: Adult Mental Health; Youth Mental Health Morbidity and Mortality Indicators: Perceived Health Status; Infant Mortality; Low Birth‐weight Babies; Premature Deaths; Cardiovascular Disease; Accidental Deaths 11 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Table 1: Indicator Data Sources Indicator Children in Poverty Single Parent Households Housing Costs Education Community Safety Environmental Quality Obesity Among Adults Obesity Among Young People Tobacco Use Among Adults Tobacco Use Among Youth Alcohol Use Among Adults Alcohol Use Among Adolescents Access to Physicians Preventable Hospitalizations Medicaid Enrollment Health Insurance Coverage Disease Prevention: Immunization Mental Health (Adults) Mental Health (Youth) Perceived Health Status Infant Mortality Low-Weight Births Premature Deaths Cardiovascular Disease Accidental Deaths Data Source Bureau of the Census, American Community Survey Bureau of the Census, American Community Survey Bureau of the Census, American Community Survey Bureau of the Census, American Community Survey Michigan State Police, Michigan Incident Crime Reporting Michigan Department of Environmental Quality Capital Area Behavioral Risk Factor Survey Michigan Behavioral Risk Factor Survey Bureau of the Census, American Community Survey Michigan Department of Education, Michigan Profile for Health Youth (MiPHY) Michigan Department of Community Health, Michigan Youth Risk Behavior Survey Capital Area Behavioral Risk Factor Survey Michigan Behavioral Risk Factor Survey Michigan Department of Education, Michigan Profile for Health Youth (MiPHY) Michigan Department of Community Health, Michigan Youth Risk Behavior Survey Capital Area Behavioral Risk Factor Survey Michigan Behavioral Risk Factor Survey Bureau of the Census, American Community Survey Michigan Department of Education, Michigan Profile for Health Youth (MiPHY) Health Resources and Services Administration, Area Resource File American Association of Medical Colleges Michigan Department of Community Health, Michigan Resident Inpatient Files Michigan Department of Community Health Bureau of the Census, Small Area Health Insurance Estimates, American Community Survey Michigan Department of Community Health, Michigan Care Improvement Registry Capital Area Behavioral Risk Factor Survey Michigan Behavioral Risk Factor Survey Michigan Department of Education, Michigan Profile for Health Youth (MiPHY) Michigan Department of Community Health, Michigan Youth Risk Behavior Survey Capital Area Behavioral Risk Factor Survey Michigan Department of Community Health, Michigan Infant Mortality Tables Michigan Department of Community Health Michigan Department of Community Health, Michigan Resident Death File Michigan Department of Community Health, Michigan Resident Death File Michigan Department of Community Health, Michigan Resident Death File Year 2006-2010 2006-2010 2006-2010 2006-2010 2010 1988-2011 2008-2010 2008-2010 2006-2010 2012 2009 2008-2010 2008-2010 2012 2009 2008-2010 2010 2006-2010 2012 2009-2010 2011 2010 2012 2009 2012 2008-2010 2010 2012 2011 2008-2010 2006-2010 2000-2010 2010 2010 2010 12 Sparrow Ionia Hospital | February 2013 Appendix P Children in Poverty Measure. Children in poverty is the percentage of children living in households with incomes below the 2010 Federal Poverty Threshold as determined annually by the Census Bureau. For 2010, the poverty threshold ranged from $15,030 for a family with one adult below age 65 and one child to as much as $43,845 for a family with two adults and seven or more children. Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Multi‐year estimates are used to estimate data for smaller areas such as cities and counties. Importance of this measure. The percentage of children in poverty has been shown to be closely associated with a variety of poor health behaviors, negative health effects, and negative outcomes including higher incidence +- of disease and premature death. Residence of Children At or Below the Poverty Level in Ingham County, 2010 (N = 12,418 children at or below poverty) Balance of County 29% Lansing 71% Source: American Community Survey, 2006‐2010 Percentage of Children In Poverty, 2010 Michigan 19.8% Six‐County SHS Service Area 17.7% Tri‐County Lansing Area Clinton County 16.7% 6.8% Eaton County 12.1% Ingham County 22.4% Gratiot County 23.0% Ionia County 21.0% Shiawassee County 0.0% 19.0% 10.0% 20.0% 30.0% Source: American Community Survey, 2006‐2010 The overall percentages of children in poverty are lower for both the Lansing tri‐ county area and the entire 6‐county SHS service area than for the entire state. The percentage of children in poverty exceeds the statewide average in Ingham, Gratiot, and Ionia counties. Of more than 12,000 children in poverty in Ingham County, 71% reside in the City of Lansing. “Kids are the poorest population in the US. They have the least voice and the people who care for them are paid the least.” 13 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Single Parent Households Source: Health Matters in San Francisco. http://www.healthmattersinsf.org/ Perecentage of Michigan Children in Single Parent Households by Race, 2010 All Michigan 9.5% Six‐County SHS Service Area 9.4% Tri‐County Lansing Area Clinton County 8.7% Ingham County 9.4% Gratiot County 10.3% Ionia County 10.8% Shiawassee County 10.3% 0% 5% 10% 15% Source: American Community Survey, 2006‐2010. Both the Tri‐county area and the six‐county service area have slightly lower percentages of single parent households than the state as a whole. Locally, the rate is highest in Ionia County at 10.8 percent and lowest in Clinton County at 7.7 percent. Both Gratiot and Shiawassee counties also have percentages higher than the statewide average at 10.3 percent. 73% Asian/Pacific Islander 7.7% Eaton County 34% African American 9.0% 8.0% 6.0% 8% Percentage of Children Living in Households Headed by a Grandparent 6.2% 5.2% 5.9% 5.8% Ingham Percentage of Single Parent Households Ionia Measure. This measure reflects the percentage of households in which a single parent is raising at least one child. Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Importance of this measure. Children in single‐parent households are at a higher risk for adverse health effects, such as emotional and behavioral problems, compared to their peers. Children in such households are more likely to develop depression, smoke, and abuse alcohol and other substances. Consequently, these children experience increased risk of morbidity and mortality of all causes. Similarly, single parents suffer from lower perceived health and higher risk of mortality. 6.6% 4.1% 4.0% 0% 20% 40% 60% 80% Source: Annie E. Casey Foundation, Kids Count data, 2012. 0.0% Source: American Community Survey, 2006‐2010. Shiawassee 25% Gratiot White (non‐Hispanic) 2.0% Eaton 41% Clinton Hispanic 14 Sparrow Ionia Hospital | February 2013 Appendix P Housing Costs Measure. This measure is the percentage of households that spend more than 30 percent of their total household income on housing. Data source & year. U.S. Census Bureau, American Community Survey 2006‐2010. Importance of this measure. The percentage of income that a family spends on housing is directly related to the amount of income available for other expenses such as health insurance, transportation, heat, child care, and food items. high in sugars and fats. Percentage of Households with Housing Costs Greater than 30% of Income, 2010 Michigan 34.8% Six‐County Region 33.7% Tri‐County Lansing Area 34.0% Clinton County 29.1% Eaton County 29.4% Ingham County 37.1% Gratiot County 30.8% Ionia County “A lot of people have left their community to find jobs or affordable housing due to these economic times.” “The way the economy is right now you have to choose between your health and paying your living expenses.” “A lot of people lost their house because they can’t cover the expensive hospital bills.” 34.5% Shiawassee County 32.6% 0% 10% 20% 30% 40% Source: U.S. Census Bureau, American Community Survey 2006‐2010, Table S2503. Both the tri‐county region and the six‐county service areas have similar portions of households with high housing costs relative to income as compared with the statewide average. Clinton and Eaton counties have a lower percentage of households in this category which may be attributed to higher average incomes in these areas. 15 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Education Measure. Educational attainment is measured by the percentage of adults who are 25 years or older who have a bachelor’s degree or a higher level of education Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Importance of this measure. There is thought to be a strong correlation between positive health outcomes and higher levels of education. There is also a well‐known relationship between higher education levels and greater economic opportunities which typically relate to healthier lifestyles. 15.0% Adults 25 and Older With Less Than a HS Diploma 12.9% 12.0% 12.9% 10.1% 9.3% 10.0% 7.0% 7.6% 5.0% Percentage of Adults over 25 with a Bachelorʹs Degree or Higher Michigan 25.0% Six‐County SHS Service Area 26.2% Tri‐County Lansing Area 31.2% Clinton County 27.2% Eaton County 24.3% Ingham County 35.5% Gratiot County 13.5% Ionia County 13.1% Shiawassee County 0.0% 14.9% 10.0% 20.0% 30.0% 40.0% Source: American Community Survey, 2006‐2010. Both the tri‐county area and the six‐county service area have higher rates of adults with college degrees compared to the statewide average. The lowest rates of educational attainment are found in Gratiot, Ionia, and Shiawassee counties where about 14 percent of people over age 25 have a bachelor’s degree or higher. This is in sharp contrast to a much higher than average rate in Ingham County, where Michigan State University is located. Shiawassee Ionia Ingham Gratiot Eaton Clinton Michigan 0.0% Source: American Community Survey, 2006‐2010. “Making the kinds of decisions that abandon or undervalue education will kill you in the end. An uneducated population dies quicker.” 16 Sparrow Ionia Hospital | February 2013 Appendix P Community Safety Measure. Community safety is represented by the rate of violent crimes per 100,000 residents per year. Violent crimes are annual incidents of murder and non‐negligent homicide, first‐degree rape, robbery, and aggravated assault, as reported by the Michigan State Police. These crimes are all crimes against people and, thus, represent the personal safety (or lack of safety) within each of the areas. Data source & year. These data are reported in the 2010 Michigan Incident Crime Reporting tabulations prepared by the Michigan State Police. Importance of this measure. In addition to reflecting the level of personal safety, crime generates stress among community residents, thus potentially undermining their psychological well‐being. High levels of crime may also deter community residents from outdoor activities and may add stress to participation in education and community activities. While all of the counties examined show lower violent crime rates than was reported for the entire state of Michigan in 2010, Ingham County exhibited only a marginally lower rate at that time. Almost two‐thirds of the violent crimes in Ingham County occurred within Lansing. This indicates a higher potential level of stress that may be associated with health problems in the city. Violent Crime per 100,000 Persons, 2010 489.9 Michigan 270.6 Six County SHS Service Area 313.2 Tri‐County Lansing Area 60.9 Clinton County 159.5 Eaton County 438.7 Ingham County 91.5 Gratiot County 156.6 Ionia County 204.3 Shiawassee County 0 100 200 300 400 500 600 Source: Michigan State Police. Michigan Incident Crime Reporting (MICR): 2010 All Offenses Reported by County/Agency. Average Number of Violent Crimes in Lansing and the Balance of Ingham County, 2008‐2010 Balance of County, 1537 Lansing, 2787 17 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Environmental Quality Measure. Water samples were tested for the level of nitrate in the water. This measure is the percentage of well water samples that exhibit nitrate levels in water that are above the Environmental Protection Agency standard of 10 milligrams per liter. Data Source & Year. Michigan Department of Environmental Quality, 1988 – 2011. This information is drawn from periodic tests of private water wells. Importance of this Measure. High nitrate levels in water may be related to the inappropriate or unsanitary disposal of human, animal, or industrial waste products. High nitrate levels in water can cause serious illnesses among infants below six months of age (methemoglobinemia). High nitrate levels may also be an indicator of other contaminants in the water. (See Michigan Department of Environmental Quality. Nitrate in Drinking Water: Information for private water well owners. (Brochure, 2003.) Source: http://www.michigan.gov/documents/deq/deqwd-gws-ciu-nitratebrochure _270430_7.pdf Percentage of Well Samples with Nitrate Levels Above the Maximum Containment Level* Michigan N.A. Tri‐County Lansing Area 0.9% Clinton 0.5% Eaton 1.4% 0.7% Ingham Gratiot 3.1% Ionia 5.2% Shiawassee 1.1% 0% 1% 2% 3% 4% 5% 6% Source: Michigan Department of Environmental Quality. 1988-2011. * These data are meaningful only for localities and households that are not served by municipal water systems that are routinely tested for contaminants. Although water quality is an important concern among environmentalists and community health specialists, environmental quality issues such as concerns about high levels of ground water contamination, air pollution, industrial pollution, or lead in house paint were also raised during the interviews and focus groups conducted for this project. “I am worried about the health effects of pesticides and steroids in food products.” “[I have concerns about] historical problems, such as abandoned manufacturing plants that have led to significant groundwater issues.” 18 Sparrow Ionia Hospital | February 2013 Appendix P Obesity Among Adults Measure. Overweight adults are defined as having a body‐mass index (BMI) of 25.0 to 29.9. Obese adults have a BMI of 30.0 and above. BMI is a calculation which takes into account both height and weight. Data source & year. BMI was calculated from height and weight data submitted by sample participants in the Behavioral Risk Factor Surveillance System surveys conducted in Michigan between 2008 and 2010. Importance of this measure. The relationship of obesity to a number of serious chronic diseases among adults has been well documented. Foremost among obesity‐related maladies are diabetes, heart disease, high blood pressure, and liver disease. Adults Who are Overweight or Obese 2008‐2010 Overweight 35.1% 6‐County Region 34.1% Tri‐County Region 32.1% Clinton County 33.9% 25.0% Eaton County 36.2% 22.0% Ingham County 30.1% Gratiot County 32.3% Ionia County 35.8% Shiawassee County “Obesity keeps increasing – if we can expand the communication and educational opportunities to make people aware of the problem, perhaps we can control this problem.” “In our obesity prevention efforts, people agree with us mentally but in practice [they] go back to offering candy as rewards.” Among interviewees, obesity was the most frequently listed top health issue in communities serviced by Sparrow Health System. 31.7% Michigan Obese 26.7% 23.8% 24.1% 49.5% 30.7% 29.3% 47.6% Source: 2008-2020 Capital Area Behavioral Risk Factor Survey; 2008-2010 Michigan BRFSS; American Community Survey, 2006-2010. Two‐thirds of adults age 18 and over in Michigan are either overweight or obese. Adults in the Tri‐County Lansing Area exhibit lower rates of overweight and obesity in most cases. Adults in Gratiot and Shiawassee counties exceed both regional and statewide levels. Obese Adults by Race and Ethnicity in Michigan, 2009 50% 42.6% 41.6% 28.7% 0% Black non‐Hispanic White non‐ Hispanic Hispanic 19 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Obesity Among Young People Measure. Overweight youth are those who are at or above the 85th percentile and below the 95th percentile for body‐ mass index (BMI) by age and sex. Obese youth are at or above the 95th percentile for BMI by age and sex. Data source & year. County data were drawn from the 2012 Michigan Profile for Healthy Youth (MiPHY) survey which is conducted among a sample of students in the 7th, 9th, and 11th grades in selected schools in selected districts in each county. Students in 31 of 72 school districts in the six‐county area participated, including those in 36 of 143 middle school buildings and 35 of 125 high school buildings. Statewide comparative data are from the 2009 Michigan Youth Risk Behavior Survey. Importance of this measure. Over‐ weight and obese youth exhibit both current and future risk factors, including risk for heart disease, diabetes, stroke, and cancer. Over‐ weight youth are also are at a greater risk for being socially stigmatized and having poor self‐esteem. “People try to fill their bellies and don’t worry about health necessarily. Families may eat better at the beginning of the month than [at] the end due to financial limitations.” “It’s a national disease frankly. I think it’s going to get worse because kids don’t go out and get exercise. Schools are cutting back on gym and athletics. It’s driven by revenue.” Youth Who Are Overweight or Obese 2011‐2012 Overweight Obese 14.2% 11.9% Michigan* 6‐County Region 15.9% 14.4% Tri‐County Region 15.6% 13.6% Clinton County 15.7% Eaton County 15.2% 15.2% Ingham County 15.2% 14.0% Shiawassee County 17.4% Ionia County 16.8% Gratiot County 17.3% 10.0% 12.3% 16.5% 18.2% * 2009 Source: Michigan Department of Education, 2012 Michigan Profile for Healthy Youth; Michigan Department of Community Health, 2009 Michigan Youth Risk Behavior Survey. Regional data calculated by PPA. * 2009 data. Between 25% and 35% of youth in each of this region’s counties are overweight or obese, with some of the highest rates reported in the more rural areas. In all cases, these rates exceed the statewide levels recorded in 2009. Overweight and Obese Youth in the Sparrow Service Area, 2011‐2012 Obese 14% Not Overweight 70% Overweight 16% 20 Sparrow Ionia Hospital | February 2013 Appendix P Tobacco Use Among Adults Measure. Tobacco use among adults is measured as the percentage of the adult population that reported smoking every day or most days and has smoked at least 100 cigarettes in their lifetime. Data source & year. Smoking data are from the 2008‐2010 Capital Area 2008‐ 2010 Michigan Behavioral Risk Factor Surveys. Importance of this measure. Despite years of publicity regarding the health dangers associated with tobacco use, about 20 to 25 percent of the adult population continues to smoke. Smoking has a variety of direct and indirect health consequences, including lung cancer, other pulmonary diseases, and heart disease. Indirect consequences include both low birth weight and the possibility of disease among those exposed to second hand smoke. As noted in the Healthy! Capital Counties CHNA Report, tobacco use may also indicate the need for smoking cessation programs or illustrate the effectiveness of existing programs. Perecentage of Current Adult Smokers Michigan 18.9% Six‐County SHS Service Area 21.6% Tri‐County Lansing Area 22.3% Clinton County† 16.4% Eaton County† 28.8% Ingham County† 21.4% Gratiot County* Ionia County* Shiawassee County* 28.8% 15.4% 18.7% 0% 5% 10% 15% 20% 25% 30% 35% † Source: 2008‐2010 Capital Area Behavioral Risk Factor Survey * Source: 2008‐2010 Michigan Behavioral Risk Factor Survey Tobacco use in the six‐county Sparrow Health System service area is slightly higher than the state as a whole. Higher percentages of adults use tobacco in Eaton and Gratiot counties, while both Clinton and Ionia counties have much smaller percentages of users. “There are programs out there to educate, but there are people who ignore it.” “[It] was a high priority five to ten years ago, but [it] seems to have dropped off.” 21 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Tobacco Use Among Youth Measure. Tobacco use among youth is measured as the percentage of young people who reported smoking cigarettes during the past 30 days. Data source & year. These data are drawn from the Michigan Department of Education, Michigan Profile for Healthy Youth (MiPHY), 2010 and the 2008‐2010 Capital Area Behavioral Risk Factor Survey. Importance of this measure. One of the successful outcomes of years of promoting the dangers of smoking and has been a decline in the prevalence of smoking among young people in recent years. Despite this, some young people continue to take up smoking each year. As is widely known, smoking has a variety of direct and indirect health consequences, including lung cancer, other pulmonary diseases, and heart disease. Indirect consequences include both low birth weight and the possibility of disease among those exposed to second hand smoke. As noted in the Healthy! Capital Counties CHNA Report, tobacco use may also indicate the need for smoking cessation programs or the effectiveness of existing programs. “I fear for smoking. I see way too many young people smoking.” “We were doing more a few years ago.” Percentage of Students Who Smoked Cigarettes in the Past 30 Days Michigan* 14.0% Six County Region 6.7% Tri‐County Lansing Area Clinton 6.1% 4.0% Eaton Ingham Gratiot Ionia Shiawassee * Michigan 2010 BRFS 9.4% 5.4% 8.9% 9.4% 9.1% 0% 2% 4% 6% 8% 10% 12% 14% 16% Source: 2008-2010 Capital Area Behavioral Risk Factor Survey; 2008-2010 Michigan Behavioral Risk Factor Survey. Within the six‐county Sparrow Health System service area the percentage of youth that report having smoked a cigarette in the last 30 days is significantly lower than that for the state as a whole. The highest rates of tobacco use are found in the more rural counties within the SHS service area. The Lansing tri‐county region has a lower rate of youth tobacco use than the six‐county region overall with the highest rate found in Eaton County. This may be indicative of the scope and reach of current and past smoking cessation efforts. 22 Sparrow Ionia Hospital | February 2013 Appendix P Alcohol Use Among Adults Measure. Binge drinking is defined as the percentage of adult males who had 5 or more and adult females who had 4 or more drinks of alcohol in a row within a short period of time during the past 30 days. Data source & year. These data are from the 2008‐2020 Capital Area Behavioral Risk Factor Survey; the 2008‐2010 Michigan Behavioral Risk Factor Survey; American Community Survey, 2006‐2010; and the Centers for Disease Control, Vital Signs, Binge Drinking. Importance of this measure. Adult binge drinking causes 80,000 deaths in the US each year and, in 2006 cost the economy $223.5 billion. This behavior can lead to increased incidents of violence, automobile accidents, suicide, unplanned pregnancies, spread of sexually transmitted diseases, and fetal alcohol syndrome. Community coalitions with a broad set of partners that includes educators, public safety, public health officials, and community leaders can help address this issue. “[We are] dealing with people who are addicted or drunk all the time. How do you motivate people to get out of where they’re stuck?” Binge Drinking Among Adults, 2008‐ 2010 Michigan* 19.7% Six‐County Region 17.8% Tri‐County Lansing Area 17.8% Clinton County 17.9% Eaton County 20.7% Ingham County 16.7% Gratiot County 18.7% Ionia County 15.8% Shiawassee County 0.0% 19.5% 10.0% 20.0% 30.0% Source: 2008‐2020 Capital Area Behavioral Risk Factor Survey; 2008‐ 2011 Michigan BRFSS; American Community Survey, 2006‐2010. 25.0% 20.0% Binge Drinking by Race and Ethnicity in Michigan, 2011 19.7% 20.5% 20.4% 21.6% 15.6% 15.0% 10.0% 5.0% 0.0% Michigan White Black Other Hispanic 23 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Alcohol Use Among Adolescents Measure. Binge drinking is defined as the percentage of students who had 5 or more drinks of alcohol in a row, that is, within a couple of hours, during the past 30 days. Data source & year. County data were drawn from the 2012 Michigan Profile for Healthy Youth (MiPHY) survey which is conducted among students in the 7th, 9th, and 11th grades in selected schools in selected districts in each county. Regional data were calculated by the authors. Students in 31 of 72 school districts in the six‐county area participated, including those in 36 of 143 middle school buildings and 35 of 125 high school buildings. Statewide data are from the 2009 Michigan Youth Risk Behavior Survey. Importance of this measure. Alcohol consumption among adolescents may have a negative effect on brain development as well as negatively effecting liver and endocrine system development. Binge drinking can also lead to risk‐taking behaviors that might result in negative health outcomes such as sexually transmitted diseases, unplanned pregnancies, traffic‐related injuries, or alcohol poisoning. Binge Drinking Among High School Students, 2011‐2012 Michigan Six‐County Region Tri‐County Lansing Area Clinton County 23.2% 12.8% 12.3% 12.8% Eaton County Ingham County Gratiot County 16.1% 10.9% 13.8% Ionia County Shiawassee County 0.0% 17.4% 10.7% 5.0% 10.0% 15.0% 20.0% 25.0% Source: American Community Survey, 2006-2010 The data indicate that the six counties that Sparrow Health System serves all perform much better than the state as a whole on this indicator. While the rates are higher in Eaton and Ingham counties, these areas are still below the statewide average. “I see a lot of alcohol being served in the area, including high school graduation parties, weddings, and party stores.” “There is still a lot of drinking and driving going on in this county. People think because you’re on a country road it’s okay.” 24 Sparrow Ionia Hospital | February 2013 Appendix P Access to Physicians 1017 Clinton County 2494 Eaton County 1907 Ingham County 762 Gratiot County 1323 Ionia County 2670 Shiawassee County 2530 0 1000 2000 3000 Source: Health Resources and Services Administration, Area Resource File, 2009-2010; American Association of Medical Colleges, 2011. While the Lansing area and the entire six‐county Sparrow Service Area have an average number of physicians available for the population served, the Lansing area and Ingham County, in particular, report more than 1 in 4 residents does not have a primary care physician. Percentage Lacking Access to a Primary Care Physician, 2008‐2010 40% 21.6% 14.8% 12.5% 14.0% 13.4% 10% NA 0% Shiawassee County 20% 29.1% 25.4% 30% Ionia County “The emergency room becomes their primary care vehicle since primary care is not really available without insurance.” Tri‐County Lansing Area Gratiot County “Ingham County is not underserved as far as number of physicians to population ratio.” 1114 Ingham County “Many people are reluctant to drive into Lansing, so if the required resources are not available many people go without” Six‐County Region Eaton County 1034 Clinton County Michigan Lansing Area Population per Primary Care Physician, 2009‐2010 Michigan Measure. The measure on the top right is the number of total residents per primary care physician (including general medicine, family practice, internal medicine, pediatrics, or gynecology). Below is the percentage of the resident population that does not have a primary care physician for routine health care needs. Data source & year. Data are from the U.S. Department of Health & Human Services, Health Resources and Services Administration (HRSA), Area Resource File, 2009‐2010, the American Association of Medical Colleges (AAMC), and the Behavioral Risk Factor Survey, 2008‐2010. Importance of this measure. Primary care serves as the gateway to health through the provision of preventive care services, treatment for basic health needs, and referrals to specialized care when needed. Lack of access to primary care may delay treatment for minor problems that, with time, may become serious concerns with life‐ threatening consequences. Source: American Community Survey, 2006‐2010 25 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Preventable Hospitalizations Measure. Preventable hospitalizations are those which typically do not require inpatient services for treatment. Common preventable hospitalizations diagnoses are diabetes for adults and asthma for children. Data source & year. These data are from the Michigan Department of Community Health, 2010 Michigan Resident Inpatient Files. Importance of this measure “High rates of Ambulatory Care Sensitive hospitalizations in a community may be an indicator of a lack of or failure of prevention efforts, a primary care resource shortage, poor performance of primary health care delivery systems, or other factors that create barriers to obtaining timely and effective care.” Michigan Department of Community Health. http://www.mdch.state.mi.us/pha/osr/CHI/HOSP/I NSTRUC2.htm 14.3 Tri‐County Lansing Area Michigan 268.4 Eaton 212.1 Clinton 181.1 Ingham 218.3 Ionia 184.2 Gratiot 325.8 Shiawassee 209.6 0 50 100 150 200 250 300 350 Source: Michigan Department of Community Health, 2010 Michigan Resident Inpatient Files. The tri‐county area has a much higher rate of preventable hospitalizations due to asthma per 10,000 children younger than 18 than does the state as a whole. Ingham County performs much worse on this measure than does Clinton or Eaton counties. (See chart at left.) Example: Preventable Hospitalizations Due to Asthma per 10,000 Children Below Age 18 Michigan Preventable Hospitalizations per 10,000 Population, 2010 21.4 12.4 Clinton County 18.1 Eaton County 25.6 Ingham County 0 10 20 30 “Routine physical exams. Yes if you have insurance. If you don’t, that’s the last thing that you’re going to do. Of all the issues, that’s probably the biggest gap. If we can catch some of this stuff earlier, it would be better/save money.” 26 Sparrow Ionia Hospital | February 2013 Appendix P Medicaid Enrollment Measure. This measure reflects the percentage of residents enrolled in any Medicaid Health Plan. Data source & year. These data are August 2012 enrollment figures from the Michigan Department of Community Health. Importance of this measure. Because accurate measurements of uninsured individuals are not standardized, accurately measuring the percentage of Medicaid enrollees can help provide firmer estimates for health insurance coverage in the region. (http://www.chis.ucla.edu/dataquali ty6.html). This indicator is also helpful in determining an area’s demand for services and providers that accept Medicaid patients. Percentage of Residents Enrolled in Medicaid Michigan 12.3% Six‐County SHS Service Area 10.6% 10.2% Tri‐County Lansing Area Clinton County Eaton County 6.2% 8.3% Ingham County 11.9% Gratiot County 12.0% Ionia County Shiawassee County 10.7% 12.2% 0% 2% 4% 6% 8% 10% 12% 14% Source: Michigan Department of Community Health, 2012 Both the tri‐county area and the six‐county service area have a lower percentage of residents enrolled in a Medicaid Health Plan than that state as a whole. Clinton County enrollment is the lowest, with only 6.2% of residents enrolled in a Medicaid Health Plan. “We’re not a physician shortage area, but we’re low on specialists in this area. Specialists don’t see uninsured or Medicaid, so we need more access to that.” “Dental and some of the specialty care is largely restricted if you’re on Medicaid. In our area, there is one dentist . . . who will see Medicaid [patients]. If [a] kid is in hospital, they [physicians] will see them, but not in office.” 27 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Health Insurance Coverage Measure. This is the percentage of the entire non‐institutionalized population that reported not having any form of health insurance, including commercial insurance, Medicare, Medicaid, military services health care, or other health insurance. Data source & year. These data are from the Bureau of the Census, 2009 Small Area Health Insurance Estimates. Regional estimates were calculated by the authors. Importance of this measure. The lack of health care insurance provides an estimate of the potential level of unmet health care needs in the community as well as the potential level of uncompensated care when uninsured individuals may need care provided by the emergency department of a local hospital. Percentage of the Population Without Health Insurance, 2009 Michigan 6‐county region 13.4% Shiawassee County 13.6% Percent Uninsured, Selected States, 2009‐2011 Average Texas 24.6% U.S. 16.1% Michigan Massachusetts 0.0% 13.9% Ionia County 14.9% Gratiot County 16.4% 3‐county region 12.9% Ingham County 14.2% Eaton County 11.3% Clinton County 0.0% 10.3% 5.0% 10.0% 15.0% 20.0% Source: Bureau for the Census, Small Area Health Insurance Estimates, 2009. Compared to the total percentage of uninsured people across the United States, Michigan has a relatively low proportion of residents without any form of health insurance. Only 13 states have a smaller proportion of their population that is uninsured. The rates presented above for Clinton, Eaton, and Ingham counties, in particular, compare very favorably with most of the rest of the nation. 12.4% 4.4% 10.0% 20.0% 30.0% Source: U.S. Census Bureau, Current Population Survey, 2009 to 2012 Annual Social and Economic Supplements. “People who don’t have health insurance put off getting care, and lot of small businesses don’t provide insurance.” “I see the real gaps where people don’t have insurance. Seems to me people who have insurance can get care. Physicians won’t take Medicaid because the reimbursement is so poor.” 28 Sparrow Ionia Hospital | February 2013 Appendix P Disease Prevention: Immunization 100% Percentage of Children Ages 19 to 35 Months with Recommended Immunizations, 2012 90% 80% 79% 81% 77% 81% 78% 76% 75% 70% 60% 50% 40% 30% 20% 10% Shiawassee Co. Ionia Co. Ingham Co. Gratiot Co. Clinton Co. Eaton Co. 0% Michigan Measure. This reflects the percentage of children 19 to 35 months of age who have received the recommended 4:3:1:3:3:1 series of immunizations (including immunization for polio, hepatitis B, measles, mumps, diphtheria, and several others). Data source & year. These data are from the Michigan Department of Community Health, Michigan Care Improvement Registry, June 2012. (http://www.mcir.org/index.html) Importance of this measure. Vaccinations received early in life provide lifelong immunity from several deadly childhood diseases (Healthy! Capital Counties, 2012). Protection against childhood diseases reduces deaths and improves long‐term health for individuals, and protects the community at large. Source: MDCH, “Michigan Immunization Timely Tips.” April 2011. “I worry about the parents who don’t follow up with immunizations. I am surprised that schools don’t do a better job.” “There is a lack of outreach and education when it comes to immunizations” Source: Michigan Department of Community Health, Michigan Care Improvement Registry, June 2012. Childhood Immunization by Race and Ethnicity, 2011 African American 64.1% 72.1% White While these figures do not represent the immunization rates for the Greater Lansing area, the general pattern of disparity in the percentage of children immunized by race and ethnicity are likely to be found in this six‐county region. 78.5% Hispanic 68.3% Michigan 0% 50% 100% 29 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Mental Health (Adults) Measure. This is the percentage of individuals age 18 and older reporting 14 or more days of poor mental health in the past 30 days. Data source & year. Data are from the 2008‐2010 Capital Area BRF & SC Survey; 2010 Michigan BRFSS; American Community Survey, 2006‐2010. Importance of this measure. The relationship between mental health and physical health is important to overall well‐being. As a determinant of quality of life, mental well‐being is positively correlated to physical well‐being. There are multiple facets to mental health included in this measure such as stress, emotional problems, and depression. Adults Reporting Poor Mental Health 2008‐2010 10.7% Michigan Six‐County Region 11.9% Tri‐County Lansing Area 11.8% “We have facilities now that we did not have 10‐15 years ago, but affordability continues to be an issue.” 6.9% Clinton County 14.5% Eaton County 12.1% Ingham County 6.4% Gratiot County 14.0% Ionia County 13.4% Shiawassee County 0% 5% 10% 15% 20% Source: 2008-2010 Capital Area BRF & SC Survey; 2010 Michigan BRFSS; American Community Survey, 20062010. While both the six‐county and the tri‐county regions register a somewhat higher percentage of adults reporting poor mental health compared to the state as a whole, Clinton and Gratiot counties perform noticeably better on this measure. “There is a gap in mental health services; we don’t have adequate resources in terms of practitioners or facilities.” Adults Reporting Poor Mental Health, by Race and Ethnicity, 2010 20.0% “Mental health services are no longer represented in the community, especially for the uninsured.” 14.7% 15.0% 10.4% 11.6% 10.4% 10.0% 5.0% 0.0% White Black Other Hispanic 30 Sparrow Ionia Hospital | February 2013 Appendix P Mental Health (Youth) Measure. This measure is the percentage of students (grades 7, 9, 11, and 12 in some cases) who report feeling sadness or hopelessness almost every day for at least 2 weeks in a row that results in not doing usual activities. This reflects feelings of stress, depression, and other emotional problems. Data source & year. These data are from the Michigan Profile for Healthy Youth Survey (MiPHY), 2012; Michigan Youth Risk Factor Survey, 2011. Importance of this measure. Mental health is an important component of overall health. Depression among youth not only may be manifest in feelings of sadness, defeat or hopelessness, but may interfere with school activities and may affect physical health as well. Adolescents With Symptoms* of Depression, 2011 Michigan 26.0% Six‐County Region 27.1% Tri‐County Lansing Area 26.7% Clinton 24.5% Eaton 27.7% Ingham 26.7% Gratiot 29.4% Ionia 29.2% Shiawassee Indicators of youth depression are slightly above the statewide average in mostly rural Gratiot and Ionia counties. Hispanic and African‐American youth report higher overall rates of depression than white youth in Michigan. Adolescents With Symptons of Depression by Race and Ethnicity, 2011 40% 30% 26.9% 0% 5% 10% 15% 20% 25% 30% 35% *Self-reported feelings of sadness or hopelessness for 2 weeks or more. Source: Michigan Department of Education; Michigan Department of Community Health. Michigan Profile for Healthy Youth, 2012 County Reports; CDC, National Center for Health Statistics, Michigan Youth Risk Behavior Survey, 2011. /mdoe.state.mi.us/MIPHYADMIN/reports/ CountyReport.aspx 34.5% 28.8% 24.3% “[We are] seeing more kids with mental health problems, but it is very difficult to find treatment for them.” White 20% 10% 0% Black Hispanic 31 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Perceived Health Status Measure. Health status is the percentage of adults who self‐ reported their health as “fair” or “poor” when asked “Would you say that in general your health is excellent, very good, good, fair, or poor?.” Data source & year. Capital Area Behavioral Risk Factor Survey 2008 – 2010; Ingham County Health Department. Importance of this measure. Perceived health status is indicative of quality of life, or those physical, emotional, and social items that contribute to one’s well‐being. Self‐ perceived health status can also be an important indicator for determining health care and health‐ related service demands for a community. Percentage of Adults with a ʺFair/Poorʺ Perceived General Health Status Michigan Six‐County SHS Service Area 3.8 Sparrow Ionia 3.75 0 1 2 3 4 5 6 17.0% Eaton County 16.0% Ingham County 16.0% Gratiot County 16.1% 11.5% 14.0% 5% 10% 15% 20% Between 14 and 16 percent of the population throughout Michigan, the six‐county SHS service area, and the Greater Lansing Area perceive their own health status as “fair” or “poor.” Ionia County is an exception as only 11 percent report relatively poor health status. 3.33 Sparrow Specialty Clinton County Source: Capital Area Behavioral Risk Factor Survey, 2008‐2010; Ingham County Health Department. 3.86 Sparrow Lansing 16.2% 0% Community Leadersʹ Perceived Area Health Status, 2012 (1 = Very Poor, 6 = Excellent) Sparrow Clinton Tri‐County Lansing Area Shiawassee County 3.66 15.5% Ionia County http://publichealth.lacounty.gov/ha/reports/ange lenos/chapter4/angel4phs.pdf Six‐County Area 14.2% Interviews conducted for Sparrow Health System asked community and health care leaders to provide their perceptions of the general health status of the Greater Lansing area. They indicated that the health of area residents is good, but not excellent. 32 Sparrow Ionia Hospital | February 2013 Appendix P Infant Mortality Measure. This is the average annual number of infant deaths for every 1,000 live births between 2006 and 2010. Data source & year. Data were obtained from the Michigan Department of Community Health, Michigan Infant Mortality Tables.; Center for Disease Control (CDC), Birth Outcomes; Center for Disease Control, Office of Minority Health and Health Disparities. Importance of this measure. According to the CDC, infant mortality is associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices. This indicator reflects factors associated with the health of the mother before and during pregnancy and also problems of infants including congenital abnormalities, pre‐term/low birth weight, Sudden Infant Death Syndrome (SIDS), and respiratory distress syndrome. Racial disparities also exist with infant mortality among African Americans occurring at nearly twice the national average, and according to the Indian Health Service, SIDS deaths among American Indian and Alaska Natives are 2.3 times the rate for non‐Hispanic white mothers. Centers for Disease Control. http://www.cdc.gov/reproductivehealth/Materna lInfantHealth/InfantMortality.htm “We could do a better job getting people who don’t have insurance hooked up earlier. We need more resources, especially at the ICHD level. A lot of it is awareness. Many of them have multiple other issues. If you have insurance or money, you get great prenatal care.” Average Annual Infant Deaths per 1,000 Live Births, 2006‐2010 Michigan 7.5 Six‐County Regioan 5.9 Tri‐County Lansing Area 6.1 Clinton County 3.9 Eaton County 5.4 Ingham County 6.3 Gratiot County 8.7 Ionia County 3.9 Shiawassee County 4.9 0 2 4 6 8 10 Source: Michigan Department of Community Health, Michigan Infant Mortality tables. http://www.mdch.state.mi.us/pha/osr/index.asp?Id=3 With the exception of Gratiot County, all of the counties in the SHS service area perform better on this indicator than the state as a whole. In Ingham County, the greatest percentage of infant deaths is reported in the city of Lansing. Average Annual Infant Deaths, Lansing & Balance of Ingham County, 2006‐2010 Balance of Ingham County 19% Lansing 81% 33 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Low‐Weight Births Low Weight Babies, Average per 1,000 Live Births Measure. Babies that weigh less than 2,500 grams (5 pounds, 8 ounces) at the time of birth are considered low birth weight babies. About one in 12 babies born in the U.S. (83.3 per 1,000 live births) weigh less than 2,500 grams. Data source & year. These data are calculated from county birth data compiled by the Michigan Department of Community Health for the year 2000 through 2010. Michigan birth data may be found at 82.8 Michigan 75.3 6‐County Region 77.2 Tri‐County Region 69.1 Clinton County 70 Eaton County 81.3 Ingham County http://www.mdch.state.mi.us/pha/osr/inde x.asp?Id=2 Importance of this measure. Low birth weight may be an indicator of the health status of mothers in a community. There are several factors responsible for low birth weight, including chronic health problems among the mothers and poor pre‐natal care. There are also several implications for low birth weight babies early in life, including breathing problems, vision problems, learning problems, hearing loss, and cerebral palsy. Low birth weight risk can be reduced through improved pre‐natal care, better nutrition, smoking cessation, and other health improvements. 71.8 Gratiot County 65.7 Ionia County 74.8 Shiawassee County 0 20 40 60 80 100 Source: Michigan Department of Community Health, Michigan Natality The incidence of low birth weight babies in this region over the past 10 years compares favorably with statewide and national figures. Low birth weight babies in both the Lansing area as well as the entire 6‐county Sparrow Health System service area are about 10 percent below the statewide rate. The highest area rates are found in mainly urban Ingham County and mainly rural Shiawassee County. “If you have insurance or money you get great prenatal care. There are just gaps for people who don’t have insurance or money.” “When you look at some of the statistics I would say the overall health status is fair to poor. Particularly looking at low birth weight babies.” 34 Sparrow Ionia Hospital | February 2013 Appendix P Premature Deaths Measure. Death prior to age 75 is considered premature death. Data source & year. These data are drawn from the Michigan Department of Community Health, Michigan Resident Death File, 2010; Importance of this measure. The percentage of an area’s population that dies before the age of 75 is indicative of deaths that might have been prevented. Examining the underlying reasons for “premature” deaths are likely to reveal community health issues that can be addressed and, if resolved, may lead to longer life among community residents. “Factors such as the percentages of adult smokers and adults with a college education are associated with premature mortality among U.S. counties. Population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.” Cheng, Erika R., and David A. Kindig. "Disparities in Premature Mortality Between High- and Low-Income US Counties." http://www.cdc.gov/pcd/issues/2012/11_0120.ht m. Percentage of Deaths Before Age 75 (Premature Death), 2010 Michigan 56% Tri‐County Lansing Area* 42% Clinton County 39% Eaton County 43% Ingham County 44% Gratiot County 42% Ionia County 51% Shiawassee County 44% 0% 10% 20% 30% 40% 50% 60% * 2012 Community Health Profile and Health Needs Assessment. Healthy! Capital Counties. Source: Michigan Department of Community Health, Michigan Resident Death File, 2010; Ingham County Health Department. Across Michigan, 56 percent of the population dies before the age of 75. Within the six‐county SHS service area Ionia has the highest mark at 51 percent with a low of 39 percent for Clinton County. Using premature death as a singular surrogate for overall community health, each of the counties in the SHS service area exhibits a healthier status than generally found throughout the entire State of Michigan. 35 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Cardiovascular Disease Measure. Deaths due to cardiovascular disease per 10,000 residents are used to represent the impact of chronic disease in the community. Data source & year. Data are from the Michigan Department of Community Health, Michigan Resident Death File, 2010; Importance of this measure. There is a strong correlation between cardiovascular disease and chronic morbidity (illness) and mortality (death). Cardiovascular disease includes coronary artery disease, stroke, cardiomyopathy, and heart failure. The highest rate of cardiovascular disease in the six‐county SHS service area is in Gratiot County. Shiawassee County is the second highest in the region with a rate close to the statewide average. All of the remaining counties in the region have rates lower than the statewide average with the lowest rate found in Eaton County. Deaths Due to Cardiovascular Disease per 10,000 Residents, 2010 Michigan 207 Tri‐County Lansing Area* 181 Clinton County 171 Eaton County 158 Ingham County 195 Gratiot County 249 Ionia County 182 Shiawassee County 209 0 100 200 300 * 2012 Community Health Profile and Health Needs Assessment. Healthy! Capital Counties. Source: Michigan Department of Community Health, Michigan Resident Death File, 2010. Deaths per 100,000 Residents from Heart Disease, Males, by Race and Ethnicity: U.S., 2008 295.6 300 “Across Michigan, Black Men have the highest rates of cardiovascular disease deaths, followed by Black Women. White Males have a higher rate of mortality from cardiovascular disease than White Women.” Healthy! Capital Counties 2012 Community Health Profile & Health Needs Assessment, 47. 235.9 200 149.1 124.7 151.9 100 0 Black American Asian/Pacific Indian/Alaska Islander Native Hispanic White, Non‐ Hispanic National Center for Health Statistics. Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD. 2012 Table 30. 36 Sparrow Ionia Hospital | February 2013 Appendix P Accidental Deaths 6‐County Region 35.3 Tri‐County Region 29.3 Clinton County 28.3 Eaton County 28.7 Ingham County 28.1 Gratiot County* 42.4 Ionia County 62.1 Shiawassee County 45.5 0 40 50 60 70 37.6 40 Male Female 30 25 20 15 10 16.1 13.3 5 5 0 Large Metro Fringe Source: CDC, Morbidity and Mortality Weekly Report. March 23, 2012 (volume 61, number 11; page 197. Source data may be found within the National Vital Statistics System. County‐level mortality file. http://www.cdc.gov/nchs/deaths.htm and http://wonder.cdc.gov/mortsql.html 30 Age‐Adjusted Motor Vehicle Death Rates per 100,000, 2007‐2009 Large Metro Central 20 Source: Michigan Department of Community Health, Michigan Resident Death File, 2010; County Health Profiles. www.mdch.state.mi.us/pha/osr/chi/profiles/frame.html 35 The graph on the right is a comparison of the rates of death due to accidental injury from traffic related incidents in the U.S. between urban and rural localities. The trends found in the six county service area are similar to this national trend data. 10 Rural The rate of death due to accidental injury is higher in Ionia and Shiawassee counties compared to both the statewide and the tri‐ county areas. 35.4 Town/City (Micropolitan) Michigan Small Metro Age‐Adjusted Death Rate Due to Accidental Injury per 100,000 Persons, 2010 Medium Metro Measure. Deaths due to accidental injury per 10,000 persons include unintentional injuries such as traffic‐ related fatalities, falls, suffocation, drowning, and poisoning. The measure excludes deaths attributed to homicide or suicide. Data source & year. The data are reported on the Michigan Department of Community Health, Michigan Resident Death File, 2010. Importance of this measure. Accidental death due to poisoning and drowning are among the leading causes of death for children and young adults. Accidental death resulting from a fall is one of the leading causes of death among people 65 and over. According to the Healthy! Capital Counties Collaborative, poor socioeconomic environments can lead to an increase in deaths due to accidental injuries. 37 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix 38 Sparrow Ionia Hospital | February 2013 Appendix P Community Health Assets ______________ Hospitals Sparrow Ionia Hospital. Ionia, Michigan General medical and surgical hospital Critical access hospital3 25 beds 524 admissions 51,303 outpatient visits 232 personnel Federally Qualified Health Clinics Both are located in Belding. Belding Health Center Belding Migrant Health Center Rural Health Clinics Charles R. Barker, Jr. DO Family Practice, PC (Belding) Family Health Center Portland (Portland) Ionia Family Practice (Ionia) Tony Balice Clinic (Ionia) 3 Critical Access Hospitals are typically located in rural areas, at least 35 miles from the nearest hospital, and furnish 24-hour emergency care services 7 days a week. Critical Access Hospitals are limited to no more than 25 inpatient beds. Centers for Medicare & Medicaid Services (CMS). http://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/CertificationandComplianc/CAHs.html 39 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Extended Care Facilities Two for‐profit nursing homes, 248 total beds Physicians and Nurses Table 2: Health Care Professionals in the Sparrow Health System Service Area, 2008 Total, Active, Non-Federal Active Medical Nurse Active Nurse County Doctors' Anesthetists Practitioners Clinton County 41 3 26 Eaton County 65 7 28 Ingham County 836 9 97 Ionia County 21 6 10 Gratiot County 48 4 10 Shiawassee County 45 9 13 1056 38 184 Area Total Active Certified Nurse Midwives 1 0 10 4 1 2 18 Total Advanced Practice Nurses 30 35 116 20 15 24 240 Source: U.S. Department of Health & Human Resources, Health Resources and Services Administration, Area Resource File, 2010. 40 Sparrow Ionia Hospital | February 2013 Appendix P Findings ______________________________ Socioeconomic Indicators The area served by Sparrow Ionia Hospital is not a prosperous community. Indicators associated with poverty are higher in this area than for the entire six‐county Sparrow Health System service area as well as for the entire state. Households that spend more than 30 percent of their income on housing costs are about average, but the area’s educational level—as indicated by the percentage of area residents with bachelor’s degree—is considerably lower than for the region or the state. Each of these indicators may relate to stress which can have negative impacts on health among area residents. Alternatively, the area is characterized by a very low violent crime rate which may reduce one potential source of stress that may be found more commonly in other locations. Indicator Location Measure Comparison Michigan 6‐County Region 19.0% 17.7% Ionia County 21.0% Michigan 6‐County Region 9.5% 9.4% Ionia County 10.8% Housing costs more than 30% of household income Michigan 6‐County Region Ionia County 34.8% 33.7% Violent crimes per 1,000 persons Michigan 6‐County Region Ionia County 489.9 270.6 Michigan 6‐County Region Ionia County 25.0% 25.2% Children in poverty Single parent families Adults with at least a Bachelor’s degree More favorable than the statewide average About average 34.5% 156.6 13.1% Less favorable than the statewide average 41 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Health Behaviors Indicators of healthy behaviors in the Sparrow Ionia Hospital service area are somewhat favorable in comparison to nearby areas and to the entire state. Smoking and drinking percentages among Ionia County residents are more favorable than average or about average. Data regarding obesity among young people, however, clearly reflects the observations of some community leaders who indicated that obesity is a major problem within this community. Indicator Location Measure Comparison Michigan 6‐County Region Ionia County 31.7% 26.7% Michigan 6‐County Region Ionia County 11.9% 14.4% Michigan 6‐County Region Ionia County 18.9% 21.6% Students who smoked in the past 30 days Michigan 6‐County Region Ionia County 14.0% 6.7% Binge drinking among adults Michigan 6‐County Region Ionia County 19.7% 17.8% Michigan 6‐County Region Ionia County 23.2% 12.8% Adults who are obese Children who are obese Adults who smoke Binge drinking among high school students More favorable than the statewide average About average 30.7% 16.5% 15.4% 9.4% 15.8% 17.4% Less favorable than statewide average 42 Sparrow Ionia Hospital | February 2013 Appendix P Access to Care An important health care need in the Sparrow Ionia Hospital service area is access to primary care services. The percentage of persons lacking access to a primary care physician in the area is slightly greater than the percentage across the entire state, but as noted below, the population per primary care physician in the area is about 2.5 times the ratio for the six‐county region or the state. This implies long waits for primary care, at best, or serious difficulty getting primary care services at all for some area residents. Indicator Location Persons per primary care physician Persons lacking access to a primary care physician Medicaid enrollment Adults reporting poor or fair health Adults reporting poor mental health More favorable than the statewide average Michigan 6‐County Region Ionia County Measure Comparison 1,034 1,114 2,670 Michigan 6‐County Region 12.5% N.A. Ionia County 13.4% Michigan 6‐County Region Ionia County 12.3% 10.6% Michigan 6‐County Region Ionia County 14.2% 16.2% Michigan 10.7% 6‐County Region Ionia County 11.9% About average 10.8% 17.4% 14.0% Less favorable than the statewide average 43 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Children’s Health Despite the issues related to accessing primary care services in Ionia County, early childhood indicators are very favorable. Both infant mortality and the incidence of low birth weight babies are lower than found elsewhere in the region or the state. In addition, although not illustrated below, 81 percent of children ages 19 to 35 months have received their recommended immunizations. This is the highest rate among the six counties served by Sparrow Health System, and is higher than the 75 percent rate for Michigan overall. Indicator Location Infant deaths per 1,000 live births Low birth weight babies per 1,000 live births More favorable than the statewide average Measure Comparison Michigan 6‐County Region 7.5 5.9 Ionia County 3.9 Michigan 6‐County Region 82.8 75.3 Ionia County 65.7 About average Less favorable than the statewide average 44 Sparrow Ionia Hospital | February 2013 Appendix P Heallth Outtcomess Morbidiity and morrtality data reported fo or the Sparrrow Ionia H Hospital serrvice area aare mainly b better than the statewiide averagee. More fav vorable ratees are reported for ambulattory‐sensitive hospitall admission ns (e.g., adm missions forr conditionss or events that are routiinely treateed in ambullatory settin ngs), deathss before age 75, and deaths due tto heart atttacks or oth her cardiova ascular pro oblems. On n the other h hand, death hs due to accidentts—which a are not the outcomes o of health staatus or heallth care butt, rather, may be the ou utcomes off risky perso onal behaviior—are alm most twice the rate in Ionia Coun nty as for th he entire Sta ate of Michiigan. Indicator Locatiion M Measure Compariison Preventa able hospitalizations p per 10,000 reesidents Michigan M 6‐County Re 6 egion Io onia Countty 268.4 NA Prematu ure deaths ((before age 75) Michigan M 6‐County Re 6 egion Io onia Countty 56% NA Michigan M Deaths d due to card diovascular disease 6‐County Re 6 egion per 10,00 00 residents Io onia Countty 207 NA Michigan M 6‐County Re 6 egion Io onia Countty 35.4 NA Deaths d due to accid dental injurry per 10,000 reesidents More favorable f than the statewide average a About averagee 184.2 51% 182 62.2 Less ffavorable than statewide averrage 445 P Sparro ow Ionia Hosspital | Publicc Policy Assocciates, Inc. Appendix 46 Sparrow Ionia Hospital | February 2013 Appendix P Community Health Issues _______________ Based on the data reported in this report and the comments collected from key interviewees within the Ionia County community, the following are the most important health issues that are facing the community at this time: Healthy Life Styles. Obesity among adults and youth and the implications of these reflections of life style choices were among the most commonly identified community health problems. These issues are widely seen as part of a larger concern with healthy life style issues including poor eating habits, lack of exercise, alcohol consumption, tobacco use, and high levels of accidental deaths that may be associated with risky behavior, including drinking and driving. Access to Primary Care Services. While this issue is reported by interviewees to be somewhat alleviated by the Sparrow Ionia Hospital Emergency Department, the Federally Qualified Health Clinic (FQHC) in Belding, and several rural health clinics within the county, these clinics do not meet all of the primary health care needs of the entire community, according to feedback from interviewees. There is a clear need for more primary care providers to bring the ratio of residents to primary care physicians closer to statewide and regional levels, thus assuring more adequate urgent care and preventive health services. Chronic Diseases. Although the mortality rate from cardiac disease in this community is about average for the six‐county region and even lower than the statewide rate, several other indicators point towards the likelihood that chronic disease is an important concern in this community. Chief among them is the rate of premature deaths (e.g., deaths prior to age 75), preventable hospital admission due to diabetes, and relatively high rates of childhood and adult obesity. In addition, as one observer interviewed for this assessment stated, despite the availability of a few primary care clinics in this community, “there are a lot of people being attended to, but there are a lot of people that have illnesses that are not being treated.” Another interviewee claims that people with chronic illnesses are “getting pushed under the rug” or, at best, are referred elsewhere. 47 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix 48 Sparrow Ionia Hospital | February 2013 Appendix P Appendix A: Methods __________________ In order to meet the needs of the community served by this hospital and to meet the requirements that are required by law, Sparrow Health System engaged in a two‐phase CHNA process beginning in 2011 and continuing through 2012. This process consisted of (1) participating as a supporting partner of the Healthy! Capital Counties’ (H!CC) region‐wide community health needs assessment, and (2) by supplementing the H!CC community health needs assessment and prioritization efforts with additional data collection, analysis, and identification of critical health care needs in the areas served by each of Sparrow Health System’s hospitals. Healthy! Capital Counties. H!CC is a collaborative effort of four acute care community hospital organizations and three area health departments that serve the Greater Lansing area, as defined by Clinton, Eaton, and Ingham counties, Michigan. The four hospital organizations are: Sparrow Health System, consisting of four community hospitals, three of which are located in the three‐county Greater Lansing region: Sparrow Hospital, Lansing, Michigan Sparrow Specialty Hospital, Lansing, Michigan Sparrow Clinton Hospital, St. Johns, Michigan Sparrow Ionia Hospital, Ionia, Michigan McLaren Greater Lansing Hayes Green Beach Memorial Hospital Eaton Rapids Medical Center The three health departments collaborating in this effort are: Ingham County Health Department, serving Ingham County, Michigan Barry‐Eaton District Health Department, serving Eaton County, Michigan Mid‐Michigan District Health Department, serving Clinton County, Michigan Additional support was provided by Physician’s Health Plan of Mid‐Michigan, McLaren Health Plan, Ingham Health Plan Corporation, and the National Association of County and City Health Officials. A‐1 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix As a partner of the Healthy! Capital Counties collaborative, Sparrow Health System participated as a member of the Steering Team that was directly responsible for overseeing the CHNA conducted within the three‐county region as well as for community dialogues conducted by H!CC to identify the greatest health care needs in the region, prioritize these needs, and incorporate them into a region‐wide (e.g., Clinton, Eaton, and Ingham counties) Community Health Improvement Plan (CHIP). Under the direct supervision of the health officers within each of the three community health departments, the H!CC CHNA was compiled from publicly‐available data resources obtained from the U.S. Bureau of the Census (American Community Survey), Michigan Department of Community Health (vital records and registries), Michigan State Police (crime statistics), Centers for Disease Control and Prevention (Behavioral Risk Factor Surveillance Survey), and the Michigan Department of Education (Michigan Profile for Healthy Youth), among others. These data were supplemented by nine focus groups conducted with Lansing area residents (including one conducted in Spanish) who may be considered medically underserved or, at a minimum, may have greater than average health care needs. These individuals consisted of adults without health insurance, those enrolled in Medicaid, unemployed residents, handicapped residents, and low‐wage workers. Data collected through these efforts were compiled in a region‐wide report that was used as the basis for a series of public community dialogues in which the findings were discussed and participants were asked to assist the professional staff in identifying the area’s most important health care needs. These needs were prioritized at a subsequent community meeting. The Collaborative’s region‐wide health improvement plan will be based on these determinations and the interests of each partner—hospitals, health departments, and others, alike—to work towards ameliorating the high priority issues. Sparrow Health System. As Sparrow Health System serves all or parts of six counties, including the three‐county Greater Lansing area, it was determined by its Executive Leadership that their participation in the Healthy! Capital Counties collaborative would need to be supplemented with additional data collection efforts in order to include these additional areas—such as the community served by Sparrow Ionia Hospital—in their assessment, and because there were some additional service area populations and issues which were not directly addressed in the H!CC assessment process. In response to this need for additional information, Sparrow Health System hired Public Policy Associates, Inc., to work with the H!CC team on their foundational community health needs assessment and to collect additional data to meet the health system’s additional information needs. A‐2 Sparrow Ionia Hospital | February 2013 Appendix P Through these efforts, the following tasks were accomplished. 1. Professional Community Health Expertise. By participating collaboratively with H!CC, the foundation for the Sparrow Health System Community Health Needs Assessments was based on the professional expertise and direction of the Health Officers and technical staff of each of the participating health departments: Renee Branch Canady, Ph.D., Health Officer, Ingham County Health Department, Lansing, Michigan Colette Scrimger, Health Officer, Barry‐Eaton District Health Department, Hastings, Michigan Marcus Cheatham, Health Officer, Mid‐Michigan District Health Department, Stanton, Michigan In addition, Lisa McCafferty, the Health Officer for the Ionia County Health Department, and Robert Lathers, the Chief Executive Officer of Ionia County Community Mental Health Services, were consulted for the Ionia County assessment. 2. Quantitative Data Collection. Much of the quantitative information contained in this report are drawn from the same resources found in the H!CC CHNA report, and most of these data were supplied by the Ingham County Health Department to Sparrow Health System through Sparrow’s participation in this collaborative. In a few cases, data were updated to reflect the availability of more recent data. In addition, Sparrow Health System’s consultants compiled some additional data elements for this assessment. Additional data elements include the following: Single parent households. Bureau of the Census, American Community Survey, 2006‐2010; Medicaid enrollment. Michigan Department of Community Health, 2012; Health insurance coverage (population without health insurance). Bureau of the Census, Small Area Health Insurance Estimates, 2009. Low birth weight babies. Michigan Department of Community Health, 2000‐ 2010. 3. Qualitative Data Collection. In order to reach a broad cross‐section of the hospitals’ service areas and in order to investigate the heath care needs and concerns of identifiable sub‐groups within the region’s population, Sparrow Health System A‐3 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix sponsored 39 one‐on‐one interviews and six focus groups as part of this assessment. Interviews were conducted in person or by telephone and typically took 45 to 60 minutes. Focus groups were scheduled for 90 minutes each; some exceeded that length of time. Interviews and focus groups were conducted between June 2012 and November 2012. Interviewees and focus group participants were mainly health care consumers who have health care insurance and who serve in their respective communities as health care leaders, elected officials, health care providers, social service workers, educators, retirees, and others, as noted below. All interviews were conducted by Public Policy Associates, Inc. staff. Interviewees included residents of each county in which a Sparrow Health System hospital is located, including Ionia County. Please note that approximately 15 percent of all interviewees were located within Ionia County, and none of the Ionia County interviewees were members of the minority groups listed below due to the relatively low proportion of minorities in this county (with the exception of prison inmates whose health care needs are overwhelmingly provided within the prison system or elsewhere). Approximately twenty‐five percent of all participants who participated in these data collection efforts are members of racial or ethnic minority groups. Racial, ethnic, and religious minority interests represented include the following: Muslim Community focus group African American focus group Medical director of an Hispanic Community organization Representatives of the East Indian Community International students from China, Taiwan, and Egypt Other community participants include the following: Community health leaders, including health care administrators and hospital board members Health care providers, including physicians, other service providers, and long‐ term care providers Educators, including one health care educator Social service providers Refugee service providers A‐4 Sparrow Ionia Hospital | February 2013 Appendix P State and local elected officials Students Retirees All interviewees and focus group participants were explicitly asked to identify the most pressing community health needs as well as their suggestions for addressing these issues. Identification of the most frequently mentioned community health needs for each hospital’s service area were combined with the findings illustrated through analysis of community health indicators to compile the findings in this report. 4. Follow‐Up/Community Health Priorities. A key follow‐up effort has been to identify how the high priority community health needs that have been identified independently through each process relate to each other, and how they collectively represent the basis upon which the most important health needs in the Sparrow Health System service area and the H!CC three‐county region will be addressed. At the time this report was completed, an illustration of the commonalities between the two sets of priorities was prepared and circulated to all of the hospitals and health departments participating in this collaborative effort for their planning activities. A‐5 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Appendix P Appendix B: Interview and Focus Group Participants ____________________________ As a supplement to the Healthy! Capital Counties (H!CC) Community Health Needs Assessment (CHNA), interviewees and focus group participants were solicited from a wide variety of community residents within the six main counties served by Sparrow Health System hospitals. Among those solicited were community leaders and health care leaders; state and local elected officials; physicians and other health care providers or workers; leaders and members of racial, ethnic, and religious minorities; educators; students; retirees; social service providers; and others. Minority group members with whom these issues were discussed include African Americans, members of the Muslim community from several different ethnic backgrounds, international students, and members of the East Indian community. Health care issues within the Hispanic community were addressed by a physician that serves the Hispanic community. International students were from China and the Middle East. The occupations or special expertise of these participants not only include expected participants such as city managers, health care administrators, and social service providers, but they also include a fitness coach, two dentists, a farmer, a former drug addict, a firefighter, a high school principal, a veterinarian, and a librarian. Almost 70 individuals participated either as interviewees or focus group participants for this project. The categories in which these individuals are classified are found in Table B‐1, below. Note that some individuals are classified in more than one category. Also note that only a subset of these individuals were interviewed with specific reference to Sparrow Ionia Hospital and the Ionia County service area. Table B-1: Interviewees and Focus Group Members, 2012 Category Number Community Leader Educator Government Official Health Care Administrator Health Care Consumer (not otherwise categorized) Health Care Provider/Health Care Worker Hospital Board Member Long-Term Care Provider Minority Community Leader 15 6 8 7 6 10 11 4 5 B‐1 P Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix Table B-1: Interviewees and Focus Group Members, 2012 Category Minority Community Member Physician Refugee Services Religious Leader Religious Minority Member Retiree Social Services Provider Student Total* Number 15 4 2 1 8 4 9 3 118 * Some individuals are in more than one category. B‐2 Sparrow Ionia Hospital | February 2013 Appendix P Dolly Parton’s Imagination Library 2012 Survey Results Total Number of children enrolled in the DPIL program 1539 Total number of families surveyed (some families have more than one child enrolled) 924 Percentage of families that responded to survey 31% Percentage of respondents enrolled one year or greater 63% Percentage of respondents enrolled more than 6 months, but less than one year 23% Percentage of respondents enrolled less than 6 months 14% Percentage of respondents that reported their child is bringing the books to them and requesting them to read to them 90% Percentage of respondents that have reported their children are spending time looking at books on their own. 93% Percentage of respondents that reported they are reading more to their children then they did before 86% Percentage of respondents that reported they have logged on to the website to use the book activity resources that are available 7% Percentage of respondents that reported they would not be able to still participate in The program if funding from community donations was NOT available 58% Appendix Q Appendix R Appendix R Appendix R