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Chapter 2:Chapter 2:Chapter 2:Chapter 2: ChildrenChildrenChildrenChildren’s Health, Safety s Health, Safety s Health, Safety s Health, Safety

and Educationand Educationand Educationand Education

Children’s Health, Safety and Education

Page 69

Quality Health Care Quality Health Care Quality Health Care Quality Health Care

The early years of a child’s life are characterized by highly dynamic

processes with far reaching implications for health, emotions and,

ultimately, the ability to learn. Physiologic systems such as the nervous,

immune, neuro-endocrine and musculoskeletal systems undergo rapid

changes that can impact healthy functioning for the remainder of a

person’s life. Positive interactions between the child and parent

contribute to the ability of the child to establish healthy relationships.

Appropriate stimulation through reading, sounds, and exposure to shapes

and colors lay the foundation for a child’s ability to learn. All of these

factors contribute to the healthy growth and development from infancy

through adulthood.

Recognizing the critical nature of the early years of a

child’s life, it becomes apparent that access to quality

health care beginning before the birth of the child is

vital. Prenatal care, well-baby checkups, timely

immunizations, and proper nutrition are as important

as the love and care given to a child by a parent.

Information that is presented in the sections that

follow stresses the importance of a mother seeking medical care as early

in the pregnancy as possible. Prenatal care that begins early and follows

a schedule recommended by health care professionals offers the best

chance for a healthy pregnancy and childbirth. Ultimately, this translates

into healthy development giving the young child the best chance to grow

physically, emotionally and intellectually.

During the early years, with the rapid development of the immune

system, well-baby checkups and immunizations that follow the

recommended timetable, enables the immune system to mature to its

ultimate capacity. The series of immunizations that are required and

recommended challenge the maturing immune system in ways that

eventually give each of us the ability to ward off disease.

The early years of a child’s life

are characterized by highly

dynamic processes with far

reaching implications for health,

emotions and, ultimately, the

ability to learn.


Page 70

In addition to medical check-ups and immunizations, health care for

young children can offer support to parents, providing information about

developmental concerns and the health problems of the children. Caught

early, many serious complications that result in long-term health concerns

can be avoided.

Pediatricians can also offer guidance about behaviors that are common in

the early years. Parents can learn about appropriate and positive

parenting skills, emphasizing the importance of positive, development-

promoting activities, such as reading to their child regularly. Discussing

parental concerns is also important for identifying issues concerning the

child or the family as early as possible.

In the mid 1990’s, a group of scientists in California began a study that

investigated the impact of early childhood events. Their groundbreaking

work has raised the awareness of professionals and parents alike to the

importance of quality experiences between a child and significant adult

figures in his or her life. The information developed in that study, coupled

with the work of researchers and clinicians around the world, speaks to

the relevance of early experiences and the need for quality, consistent

healthcare which supports the family and promotes the best chances for

the child to be healthy, happy and well-adjusted.


Page 71

Reproductive Health Influences upon early childhood growth and development

begin before the birth of the child and continue into

adolescence. Prenatal care, the age of the mother at the

child’s birth, maternal health including prenatal carei, and

social factors that include abuse and violenceii, poverty,

race/ethnicity of the mother, age of the mother at birth, pre‐

and antenatal care are factors that have the potential to

impact the child for many years. Many of these factors will be

discussed in this section and throughout this report.

Many women are facing a confluence of conditions that can

characterize a single pregnancy. Ultimately, the impact is most

deeply felt by the child and can be manifest in a broad range

of physical, emotional, behavioral and learning outcomes that

can impact the child throughout his or her lifetime.

Professionals are increasingly aware of the problems

associated with complications arising during a pregnancy and

are becoming engaged in efforts to address these concerns.

For example, the National Institute for Health & Clinical

Excellence (NICE) in Great Britainiii is currently examining the

role that social factors play in the quality of a pregnancy as

well as the outcomes.

Since 2003, approximately 17,000 live births in McLennan

County have been reported to the Texas Department of State

Health Services (detailed in table 2.1.1). Each year, the

number of reported live births in McLennan County has

increased through 2007 when 3,503 live births were recorded.

Table 2.1.1 details the number of births recorded for each zip

code reported at the time of birth. Six zip codes recoded more

than 1,000 live births during the five year (03‐07) period.

These zip codes are also the most populous areas in the

County.

Section 2 . 1

Repr

oduc

tive

Heal

th


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Zip Code

‘03 ‘04 ‘05 ‘06 ‘07 Total 03‐07

76705 489 468 489 468 452 236676706 433 405 439 422 454 2153 76708 404 383 388 452 452 2079 76707 386 381 392 424 397 1980 76710 332 319 318 352 355 167676712 205 226 241 230 269 117176643 166 172 202 196 202 93876711 164 162 148 163 169 806 76704 141 151 145 123 147 707 76657 115 91 98 125 150 579 76655 67 72 85 60 81 36576691 77 76 73 60 56 34276557 48 58 57 61 44 26876633 50 54 49 58 50 261 76664 51 33 43 44 32 203 76640 42 25 43 37 42 189 76524 31 22 34 35 27 14976624 17 33 32 29 23 13476638 21 27 23 28 25 12476701 21 20 33 22 26 122 76682 25 22 26 27 17 117 76630 25 16 20 21 21 103 76703 12 3 3 4 3 2576702 6 7 NR 2 3 1876715 7 6 2 NR 1 1676654 1 1 4 3 4 13 76714 4 5 1 NR NR 10 76798 3 2 NR NR 1 6

Total 3343 3240 3388 3446 3503 16920

Table 2.1.1 McLennan County: Live Births (2003‐2007) Source: Texas Department of State Health Services

2003 2004 2005 2006 2007

Texas births 377374 381441 385537 ND ND

Birth rates 16.51 16.69 16.87 NA NA

McLennan births 3343 3240 3388 3446 3503

Birth rates 15.04 14.57 15.24 15.50 15.76

Table 2.1.2 Birth Rates Sate of Texas, McLennan County (2003‐2007) Source: Texas Department of State Health Services

Using the most recent data available for

the state of Texas and McLennan County,

birth rates for the five years beginning in

2003 were calculated. The birth rate,

defined as the number of live births

divided by the average population (or the

population at midyear)iv has been used as

the standard for measuring changes in the

population for decades. This analysis

showed that the birth rate for the state

ranged from 16.51 to 16.87 while

McLennan County recorded rates ranging

from 15.04 to 15.76, 8.9% to 12.7% below

the rate of birth for the state.

A key predictor of birth outcomes and

child growth and development is the

prenatal care that is received during the

pregnancy. Early and regular prenatal

care is the most effective means of

promoting a healthy pregnancy giving the

expectant mother and her doctor an

opportunity to discuss diet, healthy

pregnancy, parental immunization needs

and expectations for the pregnancyv. Key

to this evaluation is an examination of the

number of visits, as well as the starting


Page 73

trimester for the care as measures to assess the quality of

prenatal care received by an expectant mother.

A recommended schedule of prenatal carevi includes:

Weeks 4 – 28: 1 visit per month (every 4 weeks)

Weeks 28 – 36: 2 visits per month (every 2 weeks)

Weeks 36 to birth: 1 visit per week

High risk pregnancies may require additional care during the

pregnancy.

The Kessner Index,vii,viii an established scale for

determining the quality of prenatal care based upon

the start date of the pregnancy, the number of

prenatal visits and the length of gestation, was used

to assess the adequacy of prenatal care for residents

of McLennan County. The analysis results indicated

if the care was adequate, inadequate or

intermediate for pregnancies reported between the

years 2003 and 2007.

Table 2.1.3 details the results of the analysis of the

adequacy of prenatal care received by mothers of

McLennan County. Using aggregate birth data for

the years 2003‐2007, the analysis examined the

percentage of mothers who received inadequate

prenatal care during their pregnancy. The results

were then compared against the average for

McLennan County. The results indicate that, on

average, 10.81% of the women giving birth in

McLennan County over the five year period (03‐07)

received inadequate prenatal care. Further, six zip

codes had higher percentages of inadequate care

than the 10.81% average value for the county with

the values ranging from 12.02% to 16.85%.

The analysis of pregnancy data from McLennan

County continued with an examination of the

average number of prenatal visits made during the course of a

Zip Code Adeq Inad Inter %

Inad 76704 384 117 206 16.55%

76701 77 19 26 15.57%

76705 1496 316 554 13.36%

76664 128 26 49 12.81%

76657 387 73 119 12.61%

76707 1138 238 604 12.02% McLennan County

11167 1827 3905 10.81%

76624 98 14 22 10.45%

76706 1366 220 567 10.22%

76524 108 15 26 10.07%

76710 1150 165 361 9.84%

76711 500 78 228 9.68%

76638 96 12 16 9.68%

76708 1368 199 512 9.57%

76655 278 34 53 9.32%

76712 882 109 180 9.31%

76643 707 86 145 9.17%

76640 128 17 44 8.99%

76630 78 9 16 8.74%

76633 200 21 40 8.05%

76557 210 20 38 7.46%

76691 256 25 61 7.31%

76682 86 8 23 0.07

Table 2.1.3 McLennan County: Inadequate Prenatal Care (2003 – 2007) Source: Texas Department of State Health Services


Page 74

pregnancy between 2003 and 2007. The results showed that, on

average, a mother received 9.5 (2005) to 9.97 (2003) prenatal

visits during the course of their pregnancy.

The next indicator examined during this analysis of McLennan

County pregnancies was the length of gestation. Pre‐term

delivery is defined as delivery prior to 37 weeks gestation.

Children born preterm are at risk for problems associated with

growth, development and academic progress. Reports indicate

that children born pre‐term exhibit more behavioral and

emotional problems, developmental challenges and cognitive

delays that can impact academic successix. Table 2.1.5 details the

results of the analysis that was performed to examine the average

length of pregnancy for each zip code in each of the five years for

which data was available. Subsequently, the zip codes were

ranked from lowest (37.1 weeks) to highest (40.0 weeks) for the

most recent year (2007).

The results of the analysis revealed that the average length of

pregnancy for each zip code was above the threshold for positive

Figure 2.1.4 Annual Average Number of Prenatal Visits for McLennan County (2003‐2007) Source: Texas Department of State Health Services

9.97

9.62

9.5

9.68

9.8

9 9.5 10 10.5

2003

2004

2005

2006

2007

Average # Prenatal Visits

Average # Prenatal Visits

Year n

2003 3274

2004 3074

2005 3228

2006 3429

2007 3476


Page 75

classification as a preterm delivery (Table 2.1.5). However, for

2007, three zip codes reported average

pregnancies of 37.8 to 37.1 weeks in duration;

gestation periods that border on classification as

preterm. Further, only twice in the five year time

frame did any zip code report an average below 37

weeks; both in 2006.

Birth outcomes can play a significant role in the

growth, development and general well‐being of a

child. The length of gestation and the birth weight

are recognized predictors of academic success,

general and socio‐emotional health,x,xi and,

ultimately, the survival of the child.xii

In the state of Texas, natality statistics for 2003

through 2006 reveal that, on average,

approximately 13.8% of all live births were

preterm. In comparison, approximately 12.6% of

U.S. births were preterm. Analysis of the birth

records (detailed in 2.1.6) received from the Texas

Department of State Health Services (DSHS) for

2003 through 2007 identified the total numbers of

pre‐term deliveries recorded between 2003 and

2007. From the analysis, it was determined that

an average of 12.22% of the births for McLennan

County were classified as pre‐term, approximately

0.4% lower than the US average and 1.6% lower

than the Texas averages.

Zip Code

2003 2004 2005 2006 2007

76630 39.7 39.3 38.7 38.5 37.1

76702 38.8 38.6 ND 34.5 37.3

76704 38.4 39.0 38.5 37.9 37.8

76643 38.7 38.8 38.4 38.5 38.1

76654 ND 37.0 39.0 39.3 38.3

76707 38.6 38.7 38.5 38.6 38.4

76640 38.6 40.2 38.4 39.0 38.4

76712 39.0 38.4 38.4 38.5 38.4

76691 39.0 39.1 38.4 38.7 38.5

76708 38.7 39.0 38.5 38.4 38.5

76655 38.6 38.8 38.8 38.0 38.5

76710 38.7 38.9 38.5 38.6 38.6

76557 38.3 38.0 38.4 38.7 38.6

76657 38.9 39.3 38.8 38.1 38.6

76706 39.0 38.6 38.5 38.3 38.6

76638 38.5 38.7 38.5 37.9 38.7

76705 38.8 38.8 38.7 38.7 38.8

76624 38.9 38.6 38.7 38.9 38.9

76711 38.6 38.8 38.4 38.4 38.9

76701 40.8 38.0 38.8 38.7 39.0

76524 38.3 38.3 39.1 38.8 39.0

76664 37.5 38.2 39.3 38.9 39.2

76682 39.1 38.4 38.6 38.5 39.4

76633 38.9 39.1 38.7 38.2 39.4

76703 38.2 39.0 39.0 36.3 40.0

76714 39.8 39.7 40.0 ND ND

76795 ND ND ND 40.0 ND

Table 2.1.5 McLennan County: Average Length of Pregnancy (weeks) by Zip Code (2003 – 2007) Source: Texas Department of State Health Services


Page 76

Zip Code Total Pre‐

term Total births

PT/Total ratio

76557 45 268 16.79%76704 107 707 15.13% 76711 116 806 14.39% 76707 273 1980 13.79% 76640 26 189 13.76%76630 14 103 13.59%76708 264 2079 12.70%76701 15 122 12.30% 76643 115 938 12.26%

(McLennan County)

2067 16920 12.22%

76706 260 2153 12.08%76657 67 579 11.57%76710 193 1676 11.52% 76705 268 2366 11.33% 76638 14 124 11.29%76655 41 365 11.23%76682 13 117 11.11%76691 38 342 11.11%76664 22 203 10.84% 76712 118 1171 10.08% 76624 13 134 9.70%76633 25 261 9.58%76524 14 149 9.40%

However, nine zip codes reported numbers

of pre‐term deliveries (as a percentage of

the total live births) that exceeded the

county average (Table 2.1.6). Four of the

nine equaled or exceeded the state average

for the 03‐07 time period. Overall, the

differences between the county average

and the individual zip codes ranged from

23.1% below the county average (76524) to

37.4% above the county average (76557).

Note: Two zip codes were eliminated from

the table because of the limited number of

live births (<100) over the five year time

period. The 76702 zip code recorded 18 live

births (4 pre‐term) and 76703 zip code with

25 recorded live births (2 pre‐term) during

the five year time frame.

Continuing the analysis of the birth data for

McLennan County, reported birth weights

were examined and classified as healthy,

low birth weight (<2,500 grams (5.5 lbs);

LBW) or very low birth weight (<1,500 grams

(3.3 lbs); VLBW). The U.S. average of

LBW/VLBW births for 03 – 06 was

approximately 8.1% of all live births,

comparable to the Texas average of 8.2%.

Table 2.1.7 details the analysis of reported birth weights for the

live births recorded during 2003 through 2007. During the five

year span, mothers in McLennan County gave birth to 1118

(6.61%) low birth weight and 278 (1.64%) very low birth weight

children, matching the state average of approximately 8.2%.

Again, a number of zip codes were eliminated from the reporting

because these areas recorded less than 100 live births during the

five years examined.

Table 2.1.6 McLennan County: Preterm Deliveries as Percentage of Total Live Births by Zip Code (2003 – 2007) Source: Texas Department of State Health Services


Page 77

Table 2.1.7 McLennan County Low Birth Weight and Very Low Birth Weight Deliveries (2003‐2007) Source: Texas Department of State Health Services

Still, the analysis revealed 9 zip codes in McLennan County with

percentages of low birth weight and very low birth weight

deliveries that exceeded the county averages of 6.61% and 1.64%

respectively. In a limited number of zip codes, the ratios of

LBW/VLBW to live births were approximately double the county

average. McLennan County was similarly compared against other

Texas counties with similar population and demographic

characteristics. Low birth weight data (2005) from four counties,

Bell, Brazos, Lubbock and Smith,

was compared against McLennan

County. Three of the four had LBW

percentages comparable to

McLennan County. Bell, Brazos,

and Smith Counties reported

annual LBW percentages of 8.0%,

7.7%, and 8.3% respectively while

Lubbock County reported 10.5%

LBW deliveries for the same time

period.

Finally, birth weight averages were

calculated for the live births

reported in each zip code in

McLennan County. Table 2.1.8

details the results of the analysis

and ranks the average birth weight

for each zip code from lowest to

highest. As evidenced by the

results, there exists an

approximately 400 gram (14.1 oz)

difference in average birth weight

between the zip codes with the

highest (76712) and lowest

(76704) averages. The results of

this component of the analysis are

supported by the results of the

low birth weight and pre‐term

delivery analysis.

Zip Code LBW VLBW <2500 g Combined VLBW/LBW

Live births

% of live births

76704 71 25 96 707 13.6%

76557 33 2 35 268 13.1%

76701 9 4 13 122 10.7%

76657 45 12 57 579 9.8%

76664 18 1 19 203 9.4%

76707 147 37 184 1980 9.3%

76708 144 33 177 2079 8.5%

76640 14 2 16 189 8.5%

(McLennan County)

1115 276 1391 16858 8.3%

76705 160 36 196 2366 8.3%

76711 52 14 66 806 8.2%

76710 109 26 135 1676 8.1%

76706 133 40 173 2153 8.0%

76630 4 4 8 103 7.8%

76638 7 2 9 124 7.3%

76655 20 6 26 365 7.1%

76643 48 16 64 938 6.8%

76633 14 2 16 261 6.1%

76682 6 1 7 117 6.0%

76712 55 13 68 1171 5.8%

76624 6 0 6 134 4.5%

76691 15 0 15 342 4.4%

76524 4 0 4 149 2.7%


Page 78

Zip Code

Year Total

2003 2004 2005 2006 2007 2003‐2007

76704 3101.4 3250.8 3258.8 2970.3 3132.4 3142.7

76702 3170.5 3260.4 3355 2509 3430.3 3145.0

76557 3265.6 3159 3383.3 3245.4 3033.5 3217.4

76707 3287.9 3231.3 3293 3202.2 3224.3 3247.7

76708 3209.5 3294.9 3246.8 3249.1 3309 3261.9

76706 3343 3243.1 3253.2 3231.9 3264.4 3267.1

76657 3321.4 3364.6 3248.5 3147.9 3258.8 3268.2

76664 3359.1 3197.6 3362.1 3097.5 3334.7 3270.2

76630 3414.6 2989.1 3288.8 3505.2 3175.1 3274.6

76710 3284.3 3419.4 3296.3 3271.9 3243.7 3303.1

76705 3336.9 3308.2 3262.4 3318.6 3315.2 3308.3

76711 3446.4 3254.7 3367.3 3191.2 3312.9 3314.5

76701 3456 3526.4 3212.4 3162.4 3283.2 3328.1

76640 3311.6 3719.1 3136 3386.7 3198.4 3350.4

76643 3361.7 3424.8 3368.4 3297.2 3315.9 3353.6

76703 2998.1 3779.7 3100.5 3749.5 3189 3363.4

76655 3470.2 3447.3 3383 3265.8 3386.5 3390.6

76633 3424.2 3446.7 3393.4 3265.2 3429.7 3391.8

76682 3558.4 3140.6 3366.7 3388.6 3548.8 3400.6

76524 3509 3371 3355.5 3339.3 3447.4 3404.4

76624 3428.7 3364.3 3487.9 3339.4 3486.3 3421.3

76638 3557.3 3374.8 3400.4 3318.6 3499 3430.0

76691 3425.2 3469.8 3416.8 3551.7 3318.5 3436.4

76714 3763.3 3152.6 ND 3515 ND 3477.0

76712 3405.2 3405.1 3969 3282.4 3365.2 3485.4

76654 3515 3799 3501.3 3657.3 3090.3 3512.6

A troubling social concern facing families and communities across

the country is teen pregnancy; births to mothers under 20 years

of age. A Center for Disease Control and Prevention (CDC) report

entitled “Estimated Pregnancy Rates by Outcome in the United

States, 1990‐2004” reported that approximately 15% of all live

births in 1990 were to mothers under age 20.xiii A decade and a

half later, teen pregnancies accounted for only 12% of all live

births. The most recent numbers indicate that only 10.20% of all

pregnancies are to teen mothers, despite a short lived spike that

occurred in 2006.

Table 2.1.8 Average Recorded Birth Weights for Identified Zip Codes in McLennan County (2003 – 2007) Source: Texas Department of State Health Services


Page 79

In the state of Texas, the most recent rankings

from the Centers for Disease Control and

Prevention (2006) ranks Texas third highest

(63.1/1000 women ages 15‐19) among the 50

states (Figure 2.1.9) for the rate of births to

women ages 15‐19. Texas ranks behind

Mississippi and New Mexico. Locally, a

comparison of Dallas County, McLennan County

and the state of Texas (Figure 2.1.10) reveals that

between 2001 and 2006 the number of births to

teen mothers, as a percentage of all births for

each year, was higher in McLennan County than

the percentages for Dallas County and the state

of Texas. However, as the graph indicates, the

percentage of teen births has declined from a

high of 8.0% in 2001, yet remains higher than the

state of Texas and Dallas County.

Figure 2.1.9 National Ranking of State Teen Birth Rates per 1000 Live Births to Women Ages 15‐19 (2006). Source: National Center for Health Statistics, Centers for Disease

Control and Prevention.

18.7

20.8

21.3

23.5

24.9

25.7

25.8

26.5

27.8

27.9

30.9

31

32.9

33.4

33.4

33.6

33.8

34

35.2

35.7

39.2

39.5

39.6

39.9

40

40.2

40.5

41.9

41.9

42

43.5

43.8

44.3

44.9

45.2

45.7

47.3

48.4

49.7

53

53.5

53.9

54.2

54.6

54.7

55.8

59.6

62

62.3

63.1

64.1

68.4

0 50 100

New Hampshire

Vermont

Massachusetts

Connecticut

New Jersey

New York

Maine

North Dakota

Rhode Island

Minnesota

Wisconsin

Pennsylvania

Iowa

Nebraska

Washington

Maryland

Michigan

Utah

Virginia

Oregon

Idaho

Illinois

Montana

California

Ohio

South Dakota

Hawaii

United States

Delaware

Kansas

Indiana

Colorado

Alaska

West Virginia

Florida

Missouri

Wyoming

DC

North Carolina

South Carolina

Alabama

Louisiana

Georgia

Kentucky

Tennessee

Nevada

Oklahoma

Arizona

Arkansas

Texas

New Mexico

Mississippi

Figure 2.1.10 Comparison of Teen Births for McLennan and Dallas Counties and the State of Texas (2001‐2005). Percentages are Births to Mothers Ages 13‐17 / All Births Source: Texas Department of State Health Services

4.0

5.0

6.0

7.0

8.0

9.0

2001 2002 2003 2004 2005 2006

Texas Dallas McLennan

Percent


Page 80

Zip Code

Total Live Births

% U17 % U20

76704 707 5.80% 26.03%

76707 1980 4.70% 24.70%

76711 806 4.59% 24.07%

76524 149 2.68% 22.15%

76706 2153 3.95% 20.58%

76682 117 3.42% 19.66%

76640 189 4.23% 19.58%

76624 134 0.00% 19.40%

76708 2079 3.08% 18.90%

76630 103 1.94% 18.45%

76705 2366 3.80% 18.34%

76664 203 5.42% 17.24%

76701 122 1.64% 17.21%

MC 16920 3.02% 17.20%

76657 579 1.04% 16.06%

76557 268 1.49% 14.18%

76710 1676 1.79% 13.19%

76691 342 0.58% 13.16%

76633 261 1.15% 7.28%

76655 365 0.55% 7.12%

76638 124 0.81% 6.45%

76712 1171 0.94% 5.89%

76643 938 1.17% 5.54%

Table 2.1.11 Teen Births (U17 and U20) by Zip Code. Teen Births as a Percentage of all Live Births (2003‐2007). Source: Texas Department of State Health Services

In McLennan County between 2003 and 2007, 16,920 live births

were recorded (Section 2.2 of this report). During that same time

period, 2,910 births (17.2%) were to mothers under age 20,

with the youngest births to two mothers 13 years of agexiv.

Table 2.1.11 below details the results of an analysis of data

received from the Texas Department of State Health

Services. The table lists, by zip code, the total number of

births and the percentage of all births to mothers under the

age of 17 (U17) and 20 (U20). The analysis also calculated

the mean value for McLennan County (17.20%). The analysis

revealed that thirteen McLennan County zip codes (Table

2.1.11) had teen birth percentages above the average

(17.20%) for the entire county.

The results of the childbirth data analysis demonstrate the

need to address prenatal and childbirth health care services

in specific zip codes within McLennan County. Further, the

children that are born preterm and/or low birth weight are at

risk for a broad range of health, safety and development

concerns beginning immediately after birth.


Page 81

Key Points to Consider Prenatal care, the age of the mother at the child’s birth, maternal health, and

social factors have the potential to impact the child for many years.

Texas ranks fifth among the 50 states in the number of teenage pregnancies.

The number of births to teen mothers was higher in McLennan County than the percentages for Dallas County and the state of Texas.

The average length of pregnancy for each zip code was above the threshold

for positive classification as a preterm delivery.

The Department of State Health Services is responsible for maintaining birth records for the state of Texas.

The birth rate for the state of Texas (2003‐2005) ranged from 16.51 to 16.87

births per 1,000 residents.

The birth rate for McLennan County during the same time period ranged from 15.04 to 15.24 live births per 1,000 residents.

Six zip codes recorded 67.5% of all live births in McLennan County between

the years 2003 and 2007.

The average percentage of preterm deliveries for McLennan County was 12.22% during the 2003‐2007 time period.

On average, 8.3% of all live births between 2003 and 2007 in McLennan

County were either Low Birth Weight or Very Low Birth Weight.


Page 82

i Lu MC, R Bragonier, ER Silver, R Bemis-Heys. (2000). Where it All Begins: The Impact of Preconceptional

and Prenatal Care on Early Childhood Development, in N Halfon, E Shulman, M Hochstein and M Shannon, eds., Building Community Systems for Young Children, UCLA Center for Healthier Children, Families and Communities.

ii Chambliss, LR. (2008). Intimate partner violence and its implication for pregnancy. Clin Obstet Gynecol. 51(2):385-97.

iii National Institute for Health and Clinical Excellence. (2008). Pregnancy and complex social factors: scope. Available at http://www.nice.org.uk/guidance/index.jsp?action=download&o=42412

iv Webster’s New World Medical Dictionary. http://www.medterms.com/script/main/art.asp?articlekey=2469. v National Institutes of Health, National Institute for Child Health & Human Development. “Care Before and

During Pregnancy - - Prenatal Care” Available at http://www.ncihd.nih.gov/womenshealth/research/pregbirth/prenatal_care.cfm

vi National Institutes of Health. Prenatal Care. Available at Medline Plus. http://www.nlm.nih.gov/medlineplus/prenatalcare.html

vii Texas Department of State Health Services. (2008). Kessner Index definition from the glossary of terms and definitions. Available at http://www.dshs.state.tx.us/chs/vstats/latest/glossary.shtm

viii Kessner, D. (1973). Institute of Medicine, Contrasts in Health Status – Vol. 1, “Infant Death: An analysis of Maternal Risk and Health Care”. National Academy of Sciences, Washington, DC. pp 58-60.

ix McCormick, MC. (2004). Preterm Delivery and Its Impact on Psychosocial and Emotional Development in Children. Available at http://www.enfant-encyclopedia.com/pages/PDF/McCormickxp.pdf

x Grunau, RE, MF Whitfield, and TB Fay. (2004). Psychosocial and Academic Characteristics of Extremely Low Birth Weight (<800g) Adolescents Who Are Free of Major Impairment Compared With Term-Born Control Subjects. Pediatrics. 114(6):725.

xi Whitaker, AG., JF Feldman, JM Lorenz, S Shen, F McNicholas, M Nieto, D McCullough, JA Pinto-Martin, and N Paneth. (2006). Motor and Cognitive Outcomes in Nondisabled Low-Birth-Weight Adolescents. Arch Pediatr Adolesc Med. 160:1040.

xii Stevenson, DK, LL Wright, JA Lemons, W Oh, SB Korones, LA Papile, CR Bauer, BJ Stoll, JE Tyson, S Shakaran, AA Afnarov, EF Donovan, RS Ehrenkrantz, and J Verter. (1998). Very low birth weight outcomes of the National Institute of Child Health & Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstetrics Gynec. 179:1632.

xiii Ventura SJ, Abma JC, Mosher WD, Henshaw SK. (2008). Estimated pregnancy rates by outcome for the United States, 1990–2004. National vital statistics reports; 56(15). Hyattsville, MD: National Center for Health Statistics.

xiv Data received from Texas Department of State Health Services. (2009).


Page 83

Figure 2.2.1 Infant Death Rates and Fetal Death Rates from DSHS 2005 Mortality Report at http://www.dshs.state.tx.us/CHS/VSTAT/latest/nmortal.shtm

Fetal Deaths The Centers for Disease Control and Prevention (CDC)

definition of "fetal death", which is based upon the definition

advanced by the World Health Organization (WHO) in 1950,

reads as follows:

Fetal death is “Death before the complete expulsion or

extraction from its mother of a product of conception,

irrespective of the duration of pregnancy; the death is

indicated by the fact that after such separation, the

fetus does not breathe or show any other evidence of

life, such as beating of the heart, pulsation of the

umbilical cord, or definite movement of voluntary

muscles.”i

Or, more simply stated as:

“The death of a fetus, after the 8th week until birth.”

In the United States, the Centers for Disease Control and

Prevention collect statistical information on "live births, fetal

deaths, and induced termination of pregnancy" from 57

Section 2 . 2

Feta

l Dea

ths


Page 84

reporting areas in the United States. While the technical

definition of the World Health Organization indicates that fetal

death occurs after the 8th week of gestation, guidelines

recommend the reporting of those fetal deaths whose birth

weight is over 350g or those more than 20 weeks gestationii.

Fetal death records in Texas are maintained by the Department of

State Health Services (DSHS) in Austin. Reporting guidelines are

established by DSHS and are described in Vital Statistics Annual

Report Technical Appendixiii . Briefly, a fetal death certificate

must be filed for any fetus weighing 350 grams or more, or if the

weight is unknown, a fetus aged twenty weeks or more. Further,

the certificate must be filed with the local registrar within five

days of the date of fetal death by the institution or person who is

responsible for the final care of the fetal remains.iv

The causes of fetal death, it is generally held, are largely unknown

in 25‐60% of all deaths.v However, fetal deaths can be attributed

to a variety of maternal or fetal conditions as well as function and

physiology related to the placenta. Included in the conditions are

the following:

Maternal Prolonged pregnancy (>42 wk) Diabetes (poorly controlled) Systemic lupus erythematosus Antiphospholipid syndrome Infection Hypertension Preeclampsia Eclampsia Hemoglobinopathy Advanced maternal age Rh disease Uterine rupture Maternal trauma or death Inherited thrombophilias

Fetal Multiple gestations Intrauterine growth restriction


Page 85

Zip Code Live Births

Fetal Dth/1000 live births

Fetal Deaths

76682 117 17.09 2

76701 122 16.39 2

76705 2366 11.83 28

76704 707 11.32 8

76708 2079 11.06 23

76706 2153 10.68 23

76657 579 10.36 6

76711 806 9.93 8

76630 103 9.71 1

76691 342 8.77 3

McLennan County

15737 8.39 132

76624 134 7.46 1

Texas NA 6.00** NA

76712 1171 5.12 6

76664 203 4.93 1

76643 938 4.26 4

76710 1676 4.18 7

76633 261 3.83 1

76707 1980 3.54 7

76689 ND ND 1

Table 2.2.2 Fetal Deaths in McLennan County (2003‐2007) ** Approximation Based upon DSHS Summary of Vital Statistics for 2005 Source: Texas Department State Health Services

Congenital abnormality Genetic abnormality Infection (i.e., parvovirus B19, CMV, Listeria) Hydrops

Placental Cord accident Abruption Premature rupture of membranes Vasa previa Fetomaternal hemorrhage Placental insufficiency

The incidence of fetal deaths in the United

States has seen a decline in recent years to a

current level of 6.22 per 1,000 live births

(2005).vi However, a distinct disparity exists

between the fetal mortality rate for non‐

Hispanic black women (11.25) and non‐Hispanic

white (4.98), American Indian/Alaska Native

(5.84), Asian/Pacific Islander (4.77), and Hispanic

women (5.43).vii In Texas, the fetal mortality

rate has seen a similar decline as the US rate

(Figure 2.3.1) until arriving at the current rate of

6.0 deaths/1,000 live births.viii

Fetal death rates (FDR) for McLennan County, as

an aggregate of the years 2003‐2007, were

calculated during this analysis. Between 2003

and 2007, 15,737 live births were recorded from

the 18 zip codes listed with reported FDRs.

These 18 zip codes reported 132 fetal deaths

during that time frame. Using the aggregate

totals of fetal deaths and live births, a mean rate

of fetal deaths for the 18 zip codes was

calculated. From the analysis, a mean fetal

death rate for the 5 years was established at

8.39 deaths/1,000 live births, 39.8% higher that

the FDR for Texas in 2005 (approximately 6.00

deaths per 1,000 live births). Further, using the

total number of live births for McLennan County


Page 86

(16,920 births) for the 03‐07 time period, the FDR drops to 7.80

fetal deaths per 1,000 live births.

The analysis that has been conducted on this data examined the

fetal death rate for the individual zip codes in McLennan County

and ranked the rates from highest to lowest. 10 zip codes were

identified with FDRs that exceeded the mean value for McLennan

County (4.5% (76691) to 103.7% (76682) above the calculated

mean for the county). In addition, 7 zip codes fell below the mean

for the county (11.1% (76624) to 56.7% (76707) below the mean).

The FDR for one zip code (76689) was not calculated because of a

lack of data about the number of live births recorded during the

five year time span.

Public health officials have made great strides to reduce the fetal

death rate. In areas where the rate exceeds the national

averages, efforts are being made to address the factors associated

with the elevated rates. In many cases, health care disparities,

economics and social and environmental factors contribute to the

elevated rates. For many women living in these conditions, the

risk to sibling children, both short term and long term, is

significant. In these conditions, there is great potential to

negatively impact the growth and development of the child.

Page 87

Key Points to Consider A wide range of factors can contribute to the death of a fetus.

The Fetal Death Rate (FDR) for the state of Texas is 6.0 deaths per 1,000 live

births (2005).

The Fetal Death Rate for McLennan County for the years 2003‐2007 is 7.80 deaths per 1,000 live births.

10 zip codes in McLennan County had Fetal Death Rates that exceeded the

county average.

Page 88

i National Center for Health Statistics. 2004. Data Definition. Fetal Death. Centers for Disease Control and

Prevention. At: http://www.cdc.gov/nchs/datawh/nchsdefs/fetaldeath.htm ii Centers for Disease Control and Prevention (PDF). State Definitions and Reporting Requirements (1997

Revision ed.). National Center for Health Statistics. http://www.cdc.gov/nchs/data/misc/itop97.pdf. iii Texas Department of State Health Services. (2008). Vital Statistics Annual Report: Technical Appendix.

Available at http://www.dshs.state.tx.us/chs/vstat/latest/tech_app.shtm iv Ibid v Lindsey, JL. (2008) Evaluation of Fetal Death. eMedicine at WebMD. Available at

http://emedicine.medscape.com/article/259165‐overview vi MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics

reports; vol. 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009. vii MacDorman MF, ML. Munson, S. Kirmeyer. (2007). Fetal and perinatal mortality, United States, 2004. Natl

Vital Stat Rep 2007; 56(3). Available at http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm#vol56. viii Texas Department of State Health Services. (2008). Summary of Vital Statistics for 2005. Available at

http://www.dshs.state.tx.us/CHS/VSTAT/latest/nsumm.shtm


Page 89

Health Care Accessibility During the early years of a child’s life, the need for adequate medical care is substantial. Yet, for many children, their needs go unmet and often times, overlooked. For decades, concerns about access to health care for children and families have been at the forefront for parents, health care professionals, government agencies and political leaders. A 1997 press release from the Agency for Healthcare Research and Quality (AHRQ) succinctly described the problem in the opening paragraph.

“Nearly 13 million of the roughly 110

million families in the United States – 11.6

percent of all families – experienced difficulties

or delays in obtaining medical care or did not

get the care that they needed during 1996,

according to estimates from the federal Agency

for Health Care Policy and Research (AHCPR).”i

A little over a decade later, concerns regarding healthcare

continues.

“Nearly 46 million Americans, or 18

percent of the population under the age of 65,

were without health insurance in 2007”.ii

Multiple factors have been cited as contributing to the

healthcare access problems facing American children and

families. Lack of healthcare insurance, transportation, low

family income, lack of available specialty services are all

recognizable barriers to access of healthcare services.iii

Parents also cite a lack of available dental care, mental health

services and specialized services as significant barriers to

obtaining adequate health care for themselves and their

children.

A 2008 report in the journal Pediatrics stated that problems

associated with access to healthcare are more prevalent in low

Section 2 . 3

Heal

th C

are

Acce

ssib

ility


Page 90

income, minority populations.iv,v The 2008 Pediatrics report

further indicated that low income, African American and Hispanic

children are more likely to receive inadequate or no healthcare

services including dental care than Anglo children.

With today’s health care costs, many families are forced to choose

between placing food on the table and seeking routine healthcare

services. Families are unable to pay for health care insurance or

do not work for employers that routinely provide basic health

insurance coverage for the employee and their family. Employers

are electing to drop health care coverage for their employees

because costs have become prohibitive. In the United States,

while a contentious debate rages on about health care reform,

millions of Americans are without health care insurance coverage.

How many is unclear and subject to interpretation. However, the

estimates indicate that as many as 46 million Americans under the

age of 65 are without insurance coverage,vi a number that could

top 52 million by the year 2010.vii Findings from a recent Gallup

poll indicate that 26.9% of Texans are without health care

insurance placing the state at the top of the list of most uninsured

residents.viii Couple these facts with the escalating costs for

medical and dental care, and many families are incapable of

obtaining the needed care, even at a time when the child is

undergoing the most rapid physiologic and developmental

changes they will see during their lifetime.

The Center for Public Policy Priorities, State of Texas Children:

2008 reports that 17,496 McLennan County children ages 0‐18

were enrolled in Texas Medicaid during 2006ix. An additional

2,363 were enrolled in CHIP (Children’s Health Insurance

Program) during that same year.x Statistics for the previous year

(2005) indicate that 10,097 children, approximately 17.3% of the

child population for McLennan County, were completely without

insurance coverage. Three years later, the number of children

without healthcare insurance had risen to 12,698 (2008) an

increase of 25.8% from the previous reported statistics.xi Further,

this data represents the limits of information available about a


Page 91

Hospitals & Clinics Zip Code Hillcrest Clinic ‐ China Spring 76633McGregor Community Clinic 76657Meyer Center Community Clinic 76701Elm Avenue Community Clinic 76704Bellmead Community Clinic 76705Connally Community Clinic 76705Hillcrest Clinic ‐ Bellmead 76705Bell's Hill Elementary and Community Clinic 76706Tom Oliver South 18th St. Community and Dental Clinic 76706Family Health Center/Family Counseling and Children Services

76707

Waco‐McLennan County Public Health District 76707HealthSouth Waco Surgical Center 76708Hillcrest Health System 76708Hillcrest Clinic ‐ MacArthur/Pediatric Pavilion 76708Women's Health Center 76708Hillcrest Highway 6 & Bosque Clinic 76710US Veterans Medical Center 76711Hillcrest Baptist Medical Center/Women and Children's Hospital

76712

Hillcrest Clinic ‐ Hewitt/Woodway 76712Hillcrest Clinic ‐ Midway 76712Providence Healthcare Network 76712Waco Lung Associates 76712Depaul Center 76712

Women, Infants, and Children (WIC) Program McGregor WIC Clinic 76657Mart Clinic 76664Washington Street WIC Clinic 76701TSTC WIC Clinic 76705Waco Drive Clinic 76707

Mental Health Clinics Avalon Center, Inc. 76524MHMR Center Heart of Texas 76701Heart of Texas Region MHMR Center 76703Waco Center for Youth 76708Twin Oaks Retirement Center 76708Lake Shore Center for Psychological Services 76710Baylor University Health Services 76798

Table 2.3.1 Health Related Facilities in McLennan County Source: Google Maps

vital piece of information related to the accessibility of health care

for children of McLennan

County.

For many families,

accessibility is

dependent upon the

proximity of healthcare

facilities to the location

of the residence.

Families living in

poverty often face

challenges regarding

transportationxii,xiii.

McLennan County is

characterized as a

population with a large

percentage of the

residents living at or

below the federally

established poverty

level. Many of these

residents are

dependent upon public

transportation to

access health care

services. It has become

vital that health care

facilities be readily

accessible to the

neighborhoods that

they serve. McLennan

County has built a

system of care for its

residents with facilities

available throughout the County. Table

2.3.1 lists the healthcare facilities and the

zip code of each facility. Figure 2.3.2, GIS


Page 92

mapping of the facility locations, provides a graphic depiction of

the facilities listed in 2.3.1. The table further identifies the zip

code associated with specialty services (WIC and mental health

services) available throughout the county.

Figure 2.3.2 Graphic Representation of Health Care Related Facility Locations in McLennan County Source: Google maps


Page 93

In addition to the need for health care services, pharmaceutical

services are vital to the health and well being of McLennan

County families. The availability of local facilities for prescription

and non‐prescription goods becomes important to a family with

no personal means of transportation who may rely on a family

member or neighbor for assistance when public transportation is

not available. Further, even during the hours that public

transportation is available, time is required to access public

transportation and make one or more transfers to get to a facility

that is many miles away.

Pharmacies Zip Code

West Drug 76691

Heb Grocery #557 76705

HEB Pharmacy 76705

Sam's Club Members Only: Pharmacy 76705

Wal‐Mart: Pharmacy 76705

HEB 76705


HEB Foods 76706

HEB Foods 76706

HEB: Pharmacy 76708

HEB Foods 76708

CVS/pharmacy 76710

HEB Pharmacy 76710

Target Stores: Pharmacy 76710

Target 76710

Walgreens 76710


CVS Pharmacy 76710

CVS/pharmacy 76711

HEB: Pharmacy 76711

Walgreens 76711

CVS/pharmacy 76712

HEB: Pharmacy 76712

Walgreens 76712


Zip Code

76691 1

76705 6

76706 2

76708 2

76710 7

76711 3

76712 4

Table 2.3.3 McLennan County Pharmacy Locations by Zip Code Source: Google maps

Table 2.3.4 McLennan County Pharmacy Locations by Zip Code Summarized Source: Google maps


Page 94

Figure 2.3.5 GIS Representation of McLennan County Pharmacy Locations (green circles) Source: Google maps


Page 95

Pharmacy locations for McLennan County, by zip code, are listed

in Table 2.3.3. A graphic representation identifies the location of

the facilities and is detailed in Figure 2.3.5. An examination of the

maps and tables indicates that access to pharmacy services is

limited in some areas of the city of Waco and in McLennan

County. For example, 76704 with the lowest median income, has

no commercial pharmacies. There are facilities that are located at

the border between 76705 and 76704 that are reported to be

within 4 blocks of stops along the dedicated bus routes for the

city.

The concerns about health care accessibility are not unique to

McLennan County. However, they are indicative of a situation that

places the health and safety of the youngest members of society

at risk.


Page 96

Key Points to Consider Nearly 46 million Americans, 18% of the population under the age of 65,

were without health insurance in 2007.

Problems associated with access to healthcare are more prevalent in low income, minority populations.

For many families, accessibility is dependent upon proximity of the

healthcare to the location of the residence.

Access to pharmacy services is limited in some areas of the city of Waco and McLennan County.


Page 97

This Page Intentionally Left Blank


Page 98

i Millions Face Barriers to Obtaining Medical Care. Press Release, November 26, 1997. Agency for Healthcare

Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/barriers.htm ii DeNavas‐Walt, C.B. Proctor, and J. Smith. (2008) Income, Poverty, and Health Insurance Coverage in the

United States: 2007. U.S. Census Bureau. iii Agency for Healthcare Research and Quality. (20088 2007 National Healthcare Disparities Report. Rockville,

MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; February 2008. AHRQ Pub. No. 08‐0041.

iv Flores, G. and SC Tomany‐Korman. 2008. Racial and Ethnic Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children. Pediatrics. 121:e286‐e298.

v Flores, G., M. Abreu, MA Olivar and B Kastner. 2009. Access Barriers to Health Care for Latino Children. Arch. Pediatric Adolescent Med. 152:1119‐1125.

vi DeNavas‐Walt, C.B. Proctor, and J. Smith. 2008. Income, Poverty, and Health Insurance Coverage in the United States: 2007. U.S. Census Bureau.

vii Gilmer, TP and RC Kronick. 2009. Hard Times and Health Insurance: How Many Americans Will Be Uninsured By 2010? Health Affairs. 28(4):w573‐7.

viii Mendes, E. 2009. Uninsured: Highest Percentage in Texas, Lowest in Mass. Percentage of adults without health insurance is up in several states. Gallup Poll. http://www.gallup.com/poll/122387/uninsured‐highest‐percentage‐texas‐lowest‐mass.aspx?version=print .

ix The Texas Kids Count Project, Center for Public Policy Priorities. 2009. State of Texas Children 2008‐2009.McLennan County. Available at http://www.cppp.org/factbook08/county_profile.php?fipse=48309&nt=1.

x Ibid. xi Ibid. xiixii Criden, M. 2008. The Stranded Poor: Recognizing the Importance of Public transportation for Low‐Income

Households. Report for National Association for State Community Services Programs. Available at http://csbg.commerce.wa.gov/Portals/_CTED/Documents/Issue%20Brief‐%20Benefits%20of%20Rural%20Public%20Transportation.pdf

xiii Shoup, L. 2009. Improving access to healthcare by improving transportation options in Transportation for America. Available at http://t4america.org/blog/2009/07/17/improving‐access‐to‐healthcare‐by‐improving‐transportation‐options/


Page 99

Maslow’s Hierarchy of Needs

Safety and Security

In his 1943 A Theory of Human Motivationi, Dr. Abraham Maslow (1908‐

1970) described a hierarchy of basic human needs that ranged from the

primitive physiological needs such as food, water, sleep, etc. (Figure 1) to

the more esoteric needs for self‐actualization and achievement of

potential.

One of the more basic ‘instinctoid’ needs described by Maslow was the

need for safety and security. The ability to attain a sense of security can

ultimately serve as the foundation for one to be able to achieve the higher

needs that include belonging, self esteem and self actualization.

Young children are especially vulnerable to their environment and events

that occur around them. The smile of a parent, a calm voice, gentle touch

all contribute to a sense of safety and security that is needed by each

human being. A supportive, positive environment can influence the

healthy development of a young child during the first years of their life.


Page 100

The interaction between a parent, sibling or other persons can have a

significant impact upon the development of the immune, neuroendocrine,

musculoskeletal and neurological systems of the body in ways that follow

the child throughout their life.

Similarly, acute (single) or chronic (repeated) exposure to traumatic

events can significantly impair the growth, development and general

wellbeing of a young child. A study that began in the mid 1990’s has

examined the impact of early childhood experiences upon later life events

and diseaseii. In this ongoing study, the

authors have found a striking correlation

between early childhood exposure to harmful

events, adult high risk behaviors and serious

disease.

The Adverse Childhood Events study of Felitti

et. al. has shown that persons exposed to eventsiii that include domestic

violence, child abuse, substance abuse, parental mental illness or children

from families with an incarcerated parent (partial listing) also reported

having engaged in high risk behaviors that included substance abuse and

sedentary life styles. Further, the same persons reported higher

incidences of diseases that included diabetes, Chronic Obstructive

Pulmonary Disease (COPD) and canceriv.

For the children of McLennan County, the sense of security and safety felt

by each child are greatly influenced by events that occur at home, school

and in the community. A stable home environment free of injuries and

abuse and neglect can go a long way to creating a sense of security in the

child that can eventually lead to that child’s ability to establish

relationships, be successful at school, and live a healthy life free of

crippling diseases. The benefits of these events can be felt by the children

of McLennan County in the same way that has been described by

professionals around the world. In the coming sections, this report will

examine the conditions of McLennan County as they relate to family

stability and the general safety of the youngest members of this

community.

“When the basic physiological needs are largely taken care of, this second layer of needs comes into play. You will become increasingly interested in finding safe circumstances, stability, protection.”v


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i Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, Vol. 50, NO. 4, pp. 370-396. ii Adverse Childhood Experiences Study. http://www.cdc.gov/nccdphp/ACE iii Adverse Childhood Experiences Definitions. http://www.cdc.gov/nccdphp/ACE/prevalence.htm#ACED iv Ibid v. Maslow, A. (1943). A Theory of Human Motivation. Psychological Review, Vol. 50, NO. 4, pp. 370-396.


Page 102


Page 103



Page 103

Infant Mortality “Infant mortality is one of the most important indicators of the

health of a nation, as it is associated with a variety of factors

such as maternal health, quality and access to medical care,

socioeconomic conditions, and public health practices.”i In

Texas, the Department of State Health Services (DSHS)

recognizes that the infant mortality rate is a reflection of a

community’s health.ii

Worldwide, the infant mortality rate is defined by the World

Health Organization and United Nations Children’s Fund as:

“The number of children who die before one

year of age in a given year divided by the

number of live births in the same year. It is

expressed as deaths per 1000 live births.” iii,iv

Nationally, the Centers for Disease Control and Prevention

defines infant mortality rate as:

“Deaths of infants aged under 1 year per 1,000 or 100,000 live births. The infant mortality rate is the sum of the neonatal and post neonatal mortality rates.”v

These same criteria are used for establishing the infant

mortality rate for the state of Texas.

In the United States, the Centers for Disease Control and

Prevention, and National Center for Health Statistics (NCHS)

collects statistical information on infant mortality from

selected locations across the country using established

guidelines for identifying and documenting deaths in neonates

and post neonates up to one year of age.vi

Section 2 . 4

Infa

nt M

orta

lity


Page 104

Figure 2.4.1 "Fiscal Years 1997 ‐ 2000 Strategic Plan," Texas Department of Health

Infant mortality records in Texas are maintained by the

Department of State Health Services (DSHS) in Austin. Reporting

guidelines established by DSHS follow the criteria established by

the World Health Organization and the Centers for Disease

Control and Prevention, National Center for Health Statistics.

Nationally, the incidence of fetal deaths has seen a decline in

recent years to a current level of 6.86 per 1,000 live births

(2006).vii In Texas, the infant mortality rate has seen a decline

similar to the US rate

(Figure 2.4.1) over the

past five decades.

However, the infant

mortality rate in Texas

currently stands at 6.5

infant deaths per 1,000

live births, up from the

2004 rate of 6.3 infant

deaths/1,000 live

births.viii

Records indicate that a

distinct disparity exists

between the infant

mortality rate of

different races /

ethnicities. Nationally, records indicate that the infant mortality

rates for African American women (13.63) differ from non‐

Hispanic Anglos (5.76), American Indian/Alaska Native (8.06),

Asian/Pacific Islander (4.89), and Hispanic women (5.53).ix

Further, infant mortality records indicate that a similar pattern

exists in the state of Texas. The rate among African American

women (12.4) is nearly double the rates of non‐Hispanic whites

(5.9) and Hispanic women (5.6).x

Infant death rates (IDR) for McLennan County, as an aggregate of

the years 2003‐2006, were calculated during this analysis.

Between 2003 and 2006, 113 infant deaths were reported from


Page 105

Zip Code

Total Live Births 03‐06

IDR

76624 0 111 0.00

76630 0 82 0.00

76638 0 99 0.00

76640 0 147 0.00

76682 0 100 0.00

76712 3 902 3.33

76691 1 286 3.50

76643 3 736 4.08

76557 1 224 4.46

76657 2 429 4.66

76633 1 211 4.74

76655 2 284 7.04

76711 5 637 7.85

76524 1 122 8.20

76706 14 1699 8.24

76705 16 1914 8.36

MC 113 13,417 8.42

76708 14 1627 8.60

76710 13 1321 9.84

76701 1 96 10.42

76664 2 171 11.70

76707 20 1583 12.63

76704 13 560 23.21

Table 2.4.2 McLennan County Aggregate Infant Mortality Rates by Zip Code (2003‐2006) ** Approximation based upon DSHS summary of vital statistics for 2005. Source: Department of State Health Services

18 zip codes in McLennan County. These same zip codes reported

12,824 of the 13417 live births for McLennan

Countyxi. The 18 zip codes are detailed in Table 2.4.2

(left). Five additional zip codes reported no infant

deaths during this time period. Using the aggregate

totals of fetal deaths and live births, a mean rate of

fetal deaths for the McLennan County was

calculated; 8.42 deaths/1,000 live births, 29.5%

higher than the IDR for Texas in 2005 (approximately

6.5 deaths per 1,000 live births)xii.

The analysis that was conducted on this data

examined the infant death rate for the individual zip

codes in McLennan County and ranked the rates

from highest to lowest. Six zip codes were identified

with IDRs that exceeded the mean value for

McLennan County. However, 16 zip codes fell below

the mean for the county with 5 reporting no infant

deaths during the 4 year period.

The causes of infant mortality can vary widely.

However, more common causes of death have been

identified. Figure 2.4.3xiii,xiv on page 3 of this section,

details the top five causes of infant death across the

United States during 2005, the latest year for which

information is available. In the United States,

congenital defects were the number one cause of

infant mortality, followed by preterm/low birth

weight deliveries and SIDS (2 and 3 respectively).


Page 106

Figure 2.4.3 5 Leading Causes of Infant Mortality in the United States (2005) Source: About.com – Palliative Care. 2006

0 2000 4000 6000

Maternal Complications of Pregnancy

Complications of the umbilical cord, placenta and membranes

Sudden Infant Death Syndrome

Preterm and low birth weight

Congenital defects

Further analysis of the records

received from Texas Department of

State Health Services (DSHS)

identified and ranked the causes of

death for the 113 infant deaths

reported during the years 2003‐

2006 in McLennan County. The

results of the analysis, detailed in

Table 2.4.4, revealed that the top

five causes of death in infants is 1)

SIDS, 2) Extreme immaturity, 3)

Other (preterm infants), 4) Primary

atelectasis of newborn, and 5)

Hypoplasia and dysplasia of lung.

The top five causes were

responsible for 55 of 113 (48.7%)

total infant deaths during the four

year period.

The data analysis that was

conducted has limitations because

of the small sample size. Most of

the zip codes reported single digit

numbers of infant deaths for the

Causes of Death Total SIDS 14Extreme immaturity 12Other preterm infants 8Primary atelectasis of newborn 6 Hypoplasia and dysplasia of lung 5 Other ill‐defined and unspecified causes of mortality 5 Neonatal cardiac failure 4Newborn affected by incompetent cervix 4Assault (homicide) by unspecified means 3Congenital diaphragmatic hernia 3 Myocarditis, unspecified 3 Newborn affected by premature rupture of membranes 3 Accidental suffocation and strangulation in bed 2Anencephaly 2Congenital malformation of the heart, unspecified 2Multiple congenital malformations, not elsewhere classified

2

Newborn affected by chorioamnionitis 2Newborn affected by other forms of placental separation and hemorrhage

2

Other cardiovascular disorders originating in the perinatal period

2

Respiratory distress syndrome of newborn 2Whooping cough, unspecified 2 All other causes of death 25

113

Table 2.4.4 Primary Causes of Infant Death, McLennan County (2003‐2006) Source: Texas Department of State Health Services


Page 107

time frame and goes counter to larger studies that exclude

samples with less than 20 records for analysis. This limitation is

noted for this analysis and should be considered when

interpreting the analysis results. Still, the information that has

been derived from this analysis can be used for identification of

areas of concern in McLennan County and the city of Waco.


Page 108

Key Points to Consider National Infant Death Rate (IDR) stands at 6.86 deaths / 1,000 live births

(2006).

Texas IDR stands at 6.5 deaths/1,000 live births (2006).

The McLennan County IDR (2003‐2006) stands at 8.42 deaths/1,000 live births.

Six zip codes in McLennan County have IDRs higher than the McLennan

County average.

SIDS and extreme immaturity are the two leading causes of infant mortality for McLennan County.


Page 109



Page 110

i MacDorman, MF, and T.J. Mathews. (2008). Centers for Disease Control and Prevention, National Center for

Health Statistics. NCHS Data Brief. Recent Trends in Infant Mortality in the United States. ii "Fiscal Years 1997 - 2000 Strategic Plan," Texas Department of Health. iii World Health Statistics 2006. (2006). Geneva, World Health Organization. iv State of the World’s Children 2006. (2006). New York, United Nation’s Children’s Fund. v Centers for Disease Control and Prevention, NCHS. (2008). Supplemental Analyses of Recent Trends in Infant

Mortality. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/infantmort.htm . vi Ibid. vii MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics

reports; vol. 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009. viii Texas Department of State Health Services. (2008). Summary of Vital Statistics for 2005. Available at

http://www.dshs.state.tx.us/CHS/VSTAT/latest/nsumm.shtm . ix MacDorman, MF, and T.J. Mathews. (2008). Centers for Disease Control and Prevention, National Center for

Health Statistics. NCHS Data Brief. Recent Trends in Infant Mortality in the United States. x Matthews, TJ, M.S., et. al. Infant Mortality Statistics from the 2005 Period Linked Birth/Infant Death Data Set.

Division of Vital Statistics. National Vital Statistics Report, Vol 57, No. 2, July 30, 2008. Available at http://www.cdc.gov/nchs/products/pubs/pubd/nvsr/nvsr.htm#vol57.

xi Data request from Texas Department of State Health Services. xii Data received from Texas Department of State Health Services (2009). xiii Morrow, A. Leading causes of infant death. Infant mortality in the United States. About.com. Available at

http://dying.about.com/od/pediatriccare/tp/leading_causes_infant_death.htm. xiv Kung HC, DL. Hoyert, JQ. Xu and SL. Murphy. E-stat deaths: preliminary data for 2005 health E-stats.

Hyattsville, MD: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimdeaths05/prelimdeaths05.htm.


Page 111

Early Childhood Injuries The Centers for Disease Control and Prevention (CDC) reports that “injury and violence are serious threats to the health and well‐being of children and adolescents in the United States. Children and adolescents are at high risk for many injuries that can lead to death or disability.” i The National Health Interview Survey defines an injury episode as a “traumatic event in which a person was injured one or more times from an external cause (e.g., a fall or a motor vehicle traffic accident).”

ii The World Health

Organization defines

injury as “the physical

damage that results

when a human body is

suddenly subjected to

energy in amounts that

exceed the threshold of

physiological tolerance

– or else the result of a

lack of one or more vital elements, such as oxygen.”iii

Children's surroundings contain many inherent hazards that

contribute to the unintentional injuries responsible for 27.7

million hospitalizations each year.iv Further, it is estimated

that the majority of unintentional injuries could be avoidedv

with appropriate precautions. People of all ages can sustain

life‐threatening unintentional injuries; however, some injuries

pose greater risks for certain age groups. The six leading

causes of injury death among children under age 19 are

transportation related (motor vehicle injuries), fires and burns,

drowning, poisoning, suffocation and falls.vi Parents and

caregivers need to know the greatest risk factors for their

children and to take the appropriate steps to reduce the risk of

unintentional injury and hospitalization.

The CDC reports that “injury and

violence are serious threats to the

health and well‐being of children

and adolescents in the United

States. Children and adolescents are

at high risk for many injuries that

can lead to death or disability.”

Section 2 . 5

Early

Chi

ldho

od In

jurie

s


Page 112

Population Characteristics Unintentional

F M

Zip Code Total Pop

Total Pop (0‐4 years)

0‐4 years

76706 29,449 1,869 11 12

76705 27,843 2,138 8 12

76710 22,552 1,413 8 9

76708 21,278 1,582 7 9

76707 17,403 1,710 <5 13

76704 7,560 759 <5 7

76643 11,279 889 6 <5

76657 8,654 630 5 <5

76524 2,434 173 <5 <5

76557 3,232 214 <5 <5

76633 3,579 210 <5 <5

76655 6,228 349 NR <5

76664 3,411 230 NR <5

76682 2,622 161 <5 <5

76691 6,342 417 <5 <5

76701 2,216 74 NR <5

76711 8,619 764 <5 <5

76712 19,233 1,167 <5 <5

76624 2,284 148 <5 NR

76630 1,779 134 <5 NR

76638 2,430 178 <5 NR

76640 3,113 210 <5 NR

Total 184,091 13,550 74 97

Percent 40.9% 53.6%

Table 2.5.1 Non Fatal Unintentional Injuries Requiring Hospitalization in McLennan County (2004‐2007) Source: Department of State Health Services NR – None reported

In the United States, one in four children under four years of age

sustains non fatal injuries.vii Injuries resulting from falls, trauma,

transportation accidents, bites/stings and overexertion are the

five leading causes of unintentional injury in very young

children.viii In addition, unintentional

strangulation/asphyxiation and drowning injuries

are common in this age group.ix Many of these

types of injury are largely preventable with

appropriate education and awareness.

Data received from the Texas Department of

State Health Services (DSHS) for the years 2004

through 2007 examined the incidence of non

fatal injuries that required hospitalization in

children ages 0‐4. Statewide, during the same

time period, 18437 hospital reported

unintentional injuries to children ages 0 through

4 were reported with rates of injury ranging from

2.2 to 2.7 injuries per 1000 children in the age

groupx.

Similarly, the data, in aggregated form for

reasons of confidentiality, was analyzed, by zip

code, for McLennan County. The results, detailed

in table 2.5.1, showed that 171 unintentional

injuries requiring hospitalization of children

under 4 years of age were reported.xi Rates of

unintentional injuries for the county ranged from

2.5 to 3.1 injuries per 1000 children in the 0‐4

age groupxii.

Further, Table 2.5.1 details the results of the

analysis which shows that 89 of the 171 injuries

(52.05%) originated in five zip codes in

McLennan County during the four years queried.

The remaining injuries were distributed between

the remaining 17 zip codes. The identification of

the causes for the hospitalizations was not provided by DSHS.


Page 113

INTENTIONAL

Female Male

Zip Code

Total Pop

Total Pop (0‐4 years)

0‐4 years

76706 29,449 1,869 <5

76705 27,843 2,138 <5

76710 22,552 1,413

76708 21,278 1,582

76707 17,403 1,710

76704 7,560 759 <5

76643 11,279 889

76657 8,654 630

76524 2,434 173

76557 3,232 214

76633 3,579 210 <5

76655 6,228 349

76664 3,411 230

76682 2,622 161

76691 6,342 417

76701 2,216 74

76711 8,619 764 <5

76712 19,233 1,167

76624 2,284 148

76630 1,779 134

76638 2,430 178

76640 3,113 210 <5

Total 184,091 13,550 <5 5

Table 2.5.2. Non Fatal Intentional Injuries Requiring Hospitalization in McLennan County (2004‐2007) Source: Department of State Health Services

A second category of injuries

requiring hospitalization of a 0‐4

year old is intentional injuries.

During the four years queried, less

than 10 hospitalizations were

reported for intentional injuries

resulting in hospitalization. The

injuries, which were not identified,

were limited to 6 zip codes in

McLennan County (detailed in

table 2.5.2).


Page 114

Key Points to Consider In the United States, one in four children under four years of age sustains

non fatal injuries.

Injuries resulting from falls, trauma, transportation accidents, bites/stings and overexertion are the five leading causes of unintentional injury in very young children in the United States.

In McLennan County, 171 unintentional injuries to children requiring

hospitalization were reported between 2004 and 2007.

In 2007, 2.8 unintentional injuries per 1000 children ages 0‐4 were reported from hospital records. Statewide, the rate of unintentional injuries was slightly higher at 2.7 unintentional injuries per 1000 children ages 0‐4.

In McLennan County, less than 10 intentional injuries to children requiring

hospitalization were reported between 2004 and 2007.


Page 115



Page 116

i Center for Disease Control and Prevention web site. http://www.cdc.gov/health/childhood.htm ii United States Department of Health & Human Services, Centers for Disease Control and Prevention (2008).

Injury in the United States: 2007 Chartbook. Available at http://www.cdc.gov/nchs/data/misc/injury2007.pdf iii Baker SP et al., eds. (1992). The injury fact book, 2nd ed. Lexington, MA, Lexington Books. iv Pitts, SR., RW. Niska, J. Xu, and CW. Burt. (2006). National Health Statistics Report. National Hospital

Ambulatory Medical Care Survey: 2006 Emergency Department Summary. Available at http://www.cdc.gov/nchs/data/nhsr/nhsr007.pdf

v Peden, M., K. Oyegbite, J. Ozanne‐Smith, AA. Hyder, C. Branche, F. Rahman, F. Rivara and K. Bartolomeos. (2008) World Health Organization. World report on child injury prevention. Available at http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf

vi Borse, NN, J. Gilchrist, AM. Dellinger, RA. Rudd, MF. Ballesteros, and DA. Sleet. (2007). Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0‐19 Year olds in the United States, 2000 – 2006. Available at http://www.cdc.gov/SafeChild/images/CDC‐ChildhoodInjury.pdf

vii ibid viii ibid ix ibid x Texas Department of State Health Services, Center for Health Statistics. 2009. Trauma. Available at

http://soupfin.tdh.state.tx.us/ xi Texas Department of State Health Services, Center for Health Statistics data request. xii Texas Department of State Health Services, Center for Health Statistics. 2009. Trauma. Available at

http://soupfin.tdh.state.tx.us/


Page 117

Child Abuse Interpersonal violence has been a significant social issue that

has plagued communities, families and individuals for

centuries. Over the past four decades though, grassroots

movements have made great strides to assist individuals who

have endured violent interpersonal relationships. Child abuse

is one of the forms of violence that has exacted a great price on

our children and the community. It continues to place huge

demands on health care, law enforcement, education, child

care and social service providers. The children are particularly

vulnerable to this violence and are hurt by our inability and/or

inaction to address the problems and the pain caused by the

violence committed at the hands of a trusted friend, parent or

partner.

“The problem of child abuse has become one of the most

significant social problems facing our nation. Recent public

opinion polls rank the problem of child abuse second only to

drug abuse as a national concern.”i Some of the greatest

atrocities committed in our society, both past and present are

against our children. The U.S. Department of Health and

Human Services has called violence toward young children a

public health crisis.

Child abuse and neglect cuts across every ethnic, economic

and geographic boundary. However, the statistics indicate

that children from birth to age 3 are the most vulnerable,

possibly reflecting the child’s lack of capacity to protect

themselves from the

abuse and neglect and

verbally communicate

their needs, fears and

pain.

Child abuse is a tragedy

that affects thousands of

The problem of child abuse

has become one of the most

significant social problems

facing our nation, ranking

second only to drug abuse.

Section 2 . 6

Child

Abu

se


Page 118

Figure 2.6.1 Confirmed / Total Investigations of Child Abuse and Neglect for McLennan County (2004‐2008) Source: Texas Department of Family and Protective Services

2115

2441

2065

2422

2194

521

620

474

489

456

0 1000 2000 3000

2004

2005

2006

2007

2008

confirmed investigations

total investigations

American children each year. National statistics show in 2007

that 740,517 children (more than 2000 children per day) were

victims of abuse and neglect with approximately 1 in 3 (31.8%)

under the age of 3. That same year, almost 5 children per day

(1,786) died as a result of the abuse, up from 1,530 the previous

year.

Nationally, 31.9% of all confirmed investigations involve children

from birth to age 3 while the 16‐17 year old victims comprise the

smallest percentage of the victims. Rates of abuse for children

under the age of 1 are 22.2 per 1,000 (boys) and 21.5 per 1,000

(girls) and drops to 5.4 per 1,000 for teenagers (ages 16‐17).ii

Finally, approximately 75.7% of the child abuse fatalities reported

nationally involved children under the age of 4. These sobering

statistics emphasize the vulnerability of this population of children

(ages 0‐3).iii

In Texas, 165,010 investigations of abuse and neglect were

conducted during 2008. Of these investigations, 25.2 percent

were confirmed by Texas Department of Family and Protective

Services (DFPS) workersiv. Further, records indicate that 228

(12.7%) child abuse related fatalities were reported in 2007, down

from 257 (16.8%) in 2006.

Each year since

2004, more than

2,000 reports

(approximately 4

reports for every

100 children) of

abuse and neglect

have been filed in

McLennan County

(Figure 2.6.1). In

2008, the most

recent year for

which data is

available, 2,194


Page 119

Zip Code Abuse events

Rate of abuse (2008)

% change from the mean

76707 57 12.62 48.30

76682 7 10.77 26.56

76705 74 10.6 24.56

76708 49 9.7 13.98

76701 4 9.55 12.22

76711 19 9.42 10.69

76704 19 9.04 6.23

76664 8 8.7 2.23

MC 456 8.51 0.00

76710 34 7.67 9.87

76643 13 7.11 16.45

76633 6 6.53 23.27 State of Texas

41,591 6.46 NA

76706 52 5.28 37.96

76691 8 4.93 42.07

76638 2 4.78 43.83

76640 4 4.23 50.29

76712 16 4.19 50.76

76657 7 3.73 56.17

76624 2 2.89 66.04

76524 1 1.96 76.97

76630 1 1.69 80.14

76655 3 1.51 82.26

76557 2 1.35 84.14

reports of abuse and neglect were filed; 456 (20.8%) were

confirmedv (Table 2.6.1). These reports of abuse involved 701

children of which 289 were under 4 years of agevi (Table 2.6.2).

Data received from the Texas Department of Family

and Protective Services for 2004 through 2008 was

analyzed. From the data, the rates of confirmed

investigations (Table 2.6.2 above) as well as the

mean values for the 5 year time frame for each zip

code in McLennan County (Table 2.6.3, left) were

calculated. The analysis revealed that the average

rate of abuse for McLennan County ranged from a

high of 11.28 confirmed investigations per 1,000

children (2005) to a low of 8.51 confirmed

investigations per 1,000 children (2008) (Figure

2.6.2). In comparison, the rate of confirmed abuse

for the state of Texas in 2008 was reported to be

6.46 confirmed incidents per 1000 childrenvii.

8.51

8.96

8.62

11.28

9.45

0 5 10 15

2008

2007

2006

2005

2004

Figure 2.6.2 McLennan County Average Rates of Confirmed Abuse / Neglect per 1000 Children (2004‐2008) Source: Texas Department of Family and Protective Services

Table 2.6.3 Rate of Confirmed Child Abuse for McLennan County Zip Codes (2008) Source: Texas Department of Family and Protective Services


Page 120

An analysis at the zip code level of the confirmed cases of abuse

and neglect was conducted for each of the five years dating back

to 2004. Table 2.6.3 details the results of the analysis for the year

2008. The average rate for McLennan County for 2008 was

calculated to be 8.51 confirmed abuse events per 1000 children.

Figure 2.6.4 Spatial Representation of Rates of Confirmed Child Abuse/1000 Children in McLennan County (2008). Source: Texas Department of Family and Protective Services

Inset detail


Page 121

The analysis identified eight zip codes with rates of abuse that

exceeded the average rate of abuse for McLennan County during

2008. The rates of abuse for the eight zip codes ranged in value

from 2.23% (76664) to 48.30% (76707) above the county average.

In addition, thirteen zip codes fell below the county average.

Finally, a review of the analysis revealed three zip codes with

rates of abuse that exceeded the average for McLennan County

for each of the five years examined (76704, 76705, and 76707).

Figure 2.6.4 and the inset offer a spatial representation of the

rates of abuse for each zip code in McLennan County during 2008.

During this same time period (2004‐2008), 10

childhood deaths related to abuse and

neglect were reported. While the specific

cause of death in each of these deaths is not

clear, the means of death typically involved

in child abuse related deaths is shaken baby

syndrome, blunt force, head trauma,

drowning, and strangulation.

The number of victims for each year did not

always match the number of confirmed

incidents of abuse. In some confirmed cases,

multiple victims are identified by the

investigation. It counts as a single

investigation, but not a single victim. For

2008, detailed in Table 2.6.5 (left) 701

victims of abuse were identified by the Texas

Department of Family and Protective

Services. Of the 711 victims, 289 (40.6%) of

the victims were in the 0‐3 age group,

approximately 8.7% above the national

average for the age group. When 4 and 5

year olds are factored into this analysis, the

percentage of all victims 5 years of age or

less jumps to 55.6%.

Zip Code

Ages 0 ‐ 3

Ages 4 ‐5

Ages 6 ‐ 17

Total

76524 1 0 0 1

76557 1 1 1 3

76624 1 0 1 2

76630 1 0 0 1

76633 1 3 6 10

76638 1 0 1 2

76640 1 0 4 5

76643 7 3 12 22

76655 0 1 2 3

76657 3 2 4 9

76664 3 2 7 12

76682 4 1 5 10

76691 4 4 12 20

76701 3 2 2 7

76704 14 1 11 26

76705 47 21 55 123

76706 34 7 28 69

76707 42 13 30 85

76708 31 16 33 80

76710 21 6 24 51

76711 14 4 14 32

76712 7 3 12 22

Valid 241 90 264 595

Missing zip code

48 11 47 106

Total 289 101 311 701

Figure 2.6.5 McLennan County Confirmed Victims by Zip Code (2008) Source: Texas Department of Family and Protective Services


Page 122

For many of these children, the ultimate result of the

investigation is removal from the home. Table 2.6.6 details the zip

code analysis of the removals for 2008 in McLennan County. In

2008, 146 children were removed from an abusive situation. Of

these children, 76 (52.1%) fell into the 0‐3 age group while

another 21 (14.4%) were either 4 or 5 years of age.

This analysis does not examine the issues

related to children living in homes with

domestic violence, a concern addressed in

Section 3.1. However, both child abuse and

domestic violence are often found to occur

simultaneously in many homes. These co‐

morbid conditions can contribute significantly

to a pattern of behavioral difficulties for

preschoolers and beyond in a young child’s

academic endeavors.

Zip Code Age Group

Total0‐3 4‐5 6‐17

76524 0 0 1 1

76557 0 1 1 2

76630 1 0 1 2

76633 0 1 0 1

76643 3 0 5 8

76655 1 0 0 1

76657 1 0 1 2

76664 1 1 1 3

76682 1 1 0 2

76691 2 1 2 5

76701 2 2 0 4

76704 3 0 1 4

76705 13 6 4 23

76706 12 2 4 18

76707 4 2 2 8

76708 5 1 10 16

76710 2 0 1 3

76711 3 1 2 6

76712 1 1 6 8

Valid 55 20 42 117

Missing zip code 21 1 7 29

Total 76 21 49 146

Figure 2.6.6 McLennan County Removals by Zip Code (2008)

Source: Texas Department of Family and Protective Services


Page 123

Key Points to Consider The United States Department of Health & Human Services views violence

against children as a public health crisis.

In 2007, more than 740,000 children were victims of abuse and neglect in the United States.

In Texas, 165,000 investigations of abuse were conducted by the Texas

Department of Family and Protective Services (DFPS) in 2008. One in four investigations of abuse against children was confirmed.

In 2007, 228 Texas children did not survive the abuse.

Between 2004 and 2008, 11,237 investigations were conducted by DFPS in McLennan County. 2,560 (22.8%) of the investigations were confirmed.

In McLennan County, the rate of child abuse and neglect (confirmed

investigations) for 2004 – 2008 ranged from 8.51 to 11.62 confirmed events per 1,000 children.

Ten children have died in McLennan County as a result of abuse and neglect

since 2004.

Multiple zip codes reported rates of abuse and neglect that exceeded the county average for each of the years between 2004 and 2008.


Page 124

i Boy Scouts of America. Youth Protection Training. Found at http://riskzone.ppbsa.org/youthprotection/ ii U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. Child

Maltreatment 2007 [online]. Washington (DC): Government Printing Office; 2009. Available from: www.acf.hhs.gov.

iii US. Department of Health and Human Services, Administration on Children, Youth, and Families. Child Maltreatment 2007 [online]. Washington (DC): Government Printing Office; 2009. Available from: www.acf.hhs.gov.

iv Texas Department of Family and Protective Services. 2007 Data Book. Available at http://www.dfps.state.tx.us/Documents/about/Data_Books_and_Annual_Reports/2007/databook/CPS_FY07.pdf

v Data received from Texas Department of Family and Protective Services, Austin, TX. 2009 vi Ibid vii Texas Department of Family and Protective Services. 2008 Data Book. Available at

http://www.dfps.state.tx.us/Documents/about/Data_Books_and_Annual_Reports/2008/databook/CPS_FY08.pdf


Quality Quality Quality Quality Child CareChild CareChild CareChild Care

Affordab

search for child care by many parents and grandparents. For many

decision about a child care provider is often a choice of cost at the

sacrifice of quality. Despite this agonizing decision forced on many low

and lower middle income families,

as they


Page 125

Child CareChild CareChild CareChild Care Affordability, accessibility and quality are key issues considered

search for child care by many parents and grandparents. For many



and lower middle income families, quality remains foremost in their minds

as they search for a child care provider.

Quality care is vital in ensuring

that young children meet a

range of

developmental needs.

care is often associated with

limited class size

teacher student ratio

established curriculums. These

criteria are designed to make

the child ready to learn upon

their entrance to a

kindergarten program.

A growing number of

professional child care

providers and educators

recognize the importance of

quality care and h

impacts the futu

young child. Healthy physical

and emotional development,

socialization, and academic

success often hinge upon the

early care and education

experiences of the child and

the family.

issues considered in the

search for child care by many parents and grandparents. For many, the



remains foremost in their minds

Quality care is vital in ensuring

that young children meet a

range of education and

developmental needs. Quality

care is often associated with

limited class size, smaller

teacher student ratios and

established curriculums. These

criteria are designed to make

the child ready to learn upon

their entrance to a

kindergarten program.

A growing number of

professional child care

providers and educators

recognize the importance of

quality care and how this

impacts the future of the

young child. Healthy physical

and emotional development,

socialization, and academic

success often hinge upon the

early care and education

experiences of the child and

the family.


Page 126

Rapid growth and development of multiple systems of the body are

characteristics of the very early years of a child’s life. The development of

the immune, neuroendocrine and nervous system can be influenced by

environmental factors. Brain development can be enhanced by

appropriate stimulation including the educational activities of quality

early education programs.

Examples of established programs that are used to

establish quality early education opportunities

include the National Association for the Education

of Young Children (NAEYC) Certification, National

Accreditation Commission (NAC) Accreditation

Program, the Texas Early Education Model (TEEM),

the Texas Rising Star (TRS) program, Texas School

Ready! Certification, and the T.E.A.C.H (Teacher

Education and Compensation Helps) model scheduled for introduction in

Texas in 2010.

The NAEYC certification and TRS program offer certifications to child care

providers who meet specific requirements. This may include extra training

of staff or lower numbers of children per adult. Child care providers

meeting the requirements are then given a certification of higher quality

care. While NAEYC and TRS focus on the inputs of child care, TEEM

focuses on mentoring teachers and improving student outputs. Each

model differs in requirements, but all seek to improve the quality of care

and education offered to young children in child care and early education

settings. The T.E.A.C.H. Early Childhood Project addresses the problems of

poor education, low compensation, and high turnover in the child care

sector by providing early childhood professional development

opportunities for teachers, directors, and family child care providers

Finally, the NAC Accreditation Program of the National Association of

Child Care Professionals offers yet another avenue for early care

education programs to document performance measures that are

indicative of quality early childhood education.

Unfortunately, finding high quality care for infants and toddlers is often

impeded by barriers that are difficult to overcome. For many, quality is

secondary to cost for many low-income families. For others, a lack of

Healthy physical and emotional

development, socialization, and

academic success often hinge upon

the early care and education

experiences of the child and the

family.


Page 127

information about available resources prevents families from accessing

quality care. Many low-income families are not familiar with specific

indicators of quality care or with the complex, often inadequate, child

care standards. Finally, infant and toddler care is more expensive to

provide than care for older children, creating a smaller supply of quality

infant and toddler care. When these barriers can be overcome, the

benefits to the child, the family and the community are significant.

Providers are often hindered in their ability to offer quality programs at

an affordable price. The high cost of offering quality child care services

has forced many centers, including subsidized care centers, to carefully

watch their budgets and reduce costs wherever possible. This may affect

the number of children served, the materials available and even the

training of staff. In a statewide Texas Association of Resource and

Referral Agencies (TACCRRA) survey, child care providers shared

information about their budget concernsi. When faced with tight budgets,

almost one quarter of surveyed providers chose to reduce their services

for children. For some child care centers, this meant cutting enrichment

programs, while others cut supplies such as paper towels and soap.

Without basic supplies, providers cannot offer children a rich learning

environment, let alone a safe setting in which to learn. Tight budgets also

restrict participation in quality improvement programs, which incur more

costs.

The care of a child at home by the parents is generally accepted as the

best quality care that a child may receive. However, many parents face

challenges related to employment, education, and other family

responsibilities that place them in a position of need for outside child

care. Many challenges face parents and providers as they struggle to

provide a positive, quality learning environment for young children. The

experiences of these children will factor heavily in their future education.

For many, the quality of care and early education may make the

difference between a successful academic career that leads to post

secondary education and training or a child dropping out of a less than

satisfactory educational experience. Whichever choice is made by the

parents, it is increasingly apparent that the quality of the early care and

education sets the stage for the future of the children of McLennan

County, Texas and the nation.


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i Texas Association of Child Care Resource and Referral Agencies and Raising Texas. (2007). Executive Summary:

Findings of Infant/Toddler Care and Education Survey. Available at

http://www.taccrra.net/docs/surveys/Executive.Summary.Survey.Infant.Toddler.Child.Care.pdf


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Child Care Capacity The Texas Department of Family and Protective Services has

oversight (regulatory) authority over center based and home

based child care services in the state of Texas. Four main

categories of child care services are recognized in Texas;

Licensed Child Care Centers, Licensed Child Care Homes,

Registered Child Care Homes, and Listed Family Homes. Each

type of child care setting differs in its capacity and

regulations.

Licensed centers are located in facilities outside of the

provider’s home and provide care for seven or more children,

age birth to 13, for less than 24 hours a day. Licensed child

care homes provide care for children aged birth to 13 in the

residence of the provider. Registered child care homes also

provide care for children aged birth to 13 in the home, but are

not licensed by the state.i Child care providers in listed family

homes may not care for more than 3 children, and are not

required to register or be licensed with the state. Unlike

licensed or registered providers, listed homes are unregulated

and not subject to visits or reviews by the state.ii McLennan

County provides child care services in each of the four types

of facilities.

McLennan County is home to approximately 44,000 children

between the ages of 0 and 13.iii With 232 centers or homes,

McLennan County has spaces to accommodate 9,683 children

(detailed in Table 2.7.1).iv Currently, there are 5 children for

each open space in a formal child care setting in McLennan

County. This same ratio exists for the state of Texas.

Section 2 . 7

Child

Car

e Ca

pacit

y


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Many low‐income families

qualify for assistance or

special programs of care and

education for their 3 and 4

year old children. In

McLennan County, there are

a limited number of available

slots for this age group of

children. However, the

number of available spaces is

dependent upon funding

received by the administering

agencies. Table 2.7.2 details

the number of children served in McLennan County enrolled in

subsidized care, public school pre‐K or Head Start programs.

Across the state, families who meet or exceed the minimum

criteria for subsidized care eligibility are not guaranteed

immediate access to child care services. Eligible families must find

a child care provider who accepts subsidies and has an available

opening for the child.

Waiting lists exist for both subsidized and non‐subsidized care,

but lists are more easily measured for families receiving child care

subsidies. Local Workforce Development Boards (LWDBs)

maintain records of eligible families and report on the number of

children on child care waiting lists. Many more families searching

Child Care Facilities Number Legal

Capacity Licensed Child Care Centers 96 9,127Licensed Child Care Homes 23 276Registered Child Care Homes 39 455Listed Family Homes (unregulated) 66 198Available Capacity for Children Under age 3 in Centers

NA

Available Capacity for Children age 3‐5 in Centers

NA

Texas Early Education Model (TEEM) classrooms

17

Table 2.7.1 Capacity of Child Care Facilities in McLennan County Source: Texas Association of Child Care Resource and Referral Agencies

Early Care and Education Number

Children (0‐12) in State subsidized child care 2,895Children (3‐4) in public pre‐kindergarten 1,711Children (3‐4) in Head Start program 780

Table 2.7.2 Children Enrolled in Early Care and Education Programs for Low‐income Families Source: Texas Association of Child Care Resource and Referral Agencies


Page 131

Figure 2.7.3 Fluctuations in Subsidized Child Care Waiting List for McLennan County (2008)

Source: Workforce Solutions of the Heart of Texas.

‐

20

40

60

80

100

120

140

160

180

Number of Child

ren

for child care services on their own are not tracked, so an exact

number of children waiting for child care is not known.

McLennan County has an average of 60 children on subsidized

care waiting lists at any given time.v Figure 2.7.3 shows the

number of McLennan County children waiting for subsidized child

care in 2008. Similar to the state‐wide waiting list, demand tends

to increase in early fall coinciding with the end of summer and the

start of school.

Child care capacity is not evenly distributed across McLennan

County. With the exception of two areas, Waco enjoys a large

capacity within the city limits. The low capacity areas of Waco

include the 76711 and 76712 zip codes, the neighborhood north

of the IH‐35 and Loop 340 junction, and the 76707 area of Waco,

bordered by the Brazos River, Valley Mills Drive and Franklin

Avenue. Several regions, both East and West of Waco, face low

capacity (small number of spaces compared to the child

population). These include 76638, 76657, 76624 and 76664, or


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McGregor, Crawford, Mart and the surrounding areas. Figure

2.7.4 details the quartile ranking (Q4–highest to Q1‐lowest) of the

child care capacity for all the zip codes in McLennan County.

Figure 2.7.4 Geospatial Analysis of Child Care Facility Capacity in McLennan County Source: Texas Department of Family and Protective Services


Page 133

Figure 2.7.5 illustrates the distribution of child care centers and

homes across McLennan County. This graphic representation

includes licensed centers, licensed homes and registered homes.

In McLennan County, there are more child care centers than child

care homes. The centers appear to be concentrated in and

around the population centers of Waco (see inset). A similar

observation has been made regarding licensed homes, which are

Inset detail

Figure 2.7.5 Geospatial Analysis of Licensed Child Care Facilities in McLennan County Source: Texas Department of Family and Protective Services


Page 134

primarily located in the western areas of Waco. Few licensed

homes operate outside of the Waco city limits. Further, registered

child care homes, while more evenly distributed across the

county, are fewer in number than licensed centers. Finally, the

map does not include the final form of child care facility, the listed

family homes. These homes are unregulated and have a

maximum capacity of 3 children. McLennan County currently has

80 listed homes in operation.

An examination of the distribution of child care facilities across

the county readily reveals the low capacity areas. For example,

the 76711 area code features only 2 child care centers and 1

licensed home, while dozens of centers and homes are in

operation directly north of the 76711 area. Axtell (76624) has one

child care center, and McGregor (76657) has two. In addition,

Axtell has one listed family home while McGregor has 6, each with

a maximum capacity of 3 children.

The distribution of the limited number of facilities, in conjunction

with a 5:1 child to available spaces ratio in McLennan County,

contributes to parents’ struggle to provide quality care for their

young children. In the next section, we begin to examine the

services and programs that are available for McLennan County

children.


Page 135

Key Points to Consider McLennan County is home to approximately 44,000 children between the

ages of 0 and 13.

Across the county, 232 centers can provide services for approximately 9,700 children.

There are 5 children for every child care slot in McLennan County.

An average of 60 children are on the subsidized child care waiting list for any

given month. August is the peak month, coincidental to the start of the public school year and end of summer.

The capacity for child care services varies throughout McLennan County

with the highest capacity located within the city limits of Waco.


Page 136

i Workforce Solutions Concho Valley. (2008). Child Care Provider Manual. ii Texas Department of Family and Protective Services. (2009). Child Care Solutions: Exploring Your Options iii Texas Department of Family and Protective Services. (2008). 2008 Data Book iv Texas Department of Family and Protective Services. (2009). About Child Care Licensing. v Workforce Solutions of the Heart of Texas. (2009). Open records request.


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Child Care Affordability In addition to capacity, child care affordability is a concern for

many families in McLennan County and across Texas. Child

care costs can reach thousands of dollars a year and many

families cannot afford full time care. This is especially true of

infant care, which is more expensive than child care for

toddlers and school‐age children.

In Texas, a family of four

earning less than

$50,600 annually may

be eligible for

subsidized child care.

This is the maximum

limit, but locally

determined eligibility

limits are typically

lower. Family eligibility,

is based on a federally

determined maximum

amount of income that

equals 85% of the state median income (SMI) per household.i

Table 1 compares the Federal Poverty Level (FPL) for a family

of four to the Texas SMI.

Maximum income limits are set by the state, but Local

Workforce Development Boards (LWDBs) have the latitude to

set subsidy rates and family co‐payments. Funding for

subsidized child care in Texas comes largely from the Child

Care Development Block Grant (CCDBG), a federal subsidy

which is distributed among the 28 LWDBs across the state.

While LWDBs determine reimbursement rates locally, the

highest rates are generally paid to licensed centers caring for

infants.

LWDBs also have the freedom to

pay higher reimbursement rates

Section 2 . 8

Child

Car

e Af

ford

abili

ty

FPL Income SMI

100% = $20,650 = 35%

125% = $25,813 = 43%

150% = $30,975 = 52%

200% = $41,300 = 70%

230% = $47,495 = 80%

245% = $50,593 = 85%

Figure 2.8.1 Comparison of Federal Poverty Level Against State Median Income for Established Income Levels Data Source: US Census.


Page 138

to child care providers participating in quality improvement

programs such as the National Association for the Education of

Young Children (NAEYC) certification program, Texas Rising Star

Program, Texas School Ready! Certification or Texas Early

Education Model. Unfortunately, if LWBDs choose to increase

reimbursements for quality improvement, they must do so using

the same money that would otherwise be used to reimburse

other local providers. This limited funding does little to encourage

LWDBs to promote quality improvement. In order to ensure

availability, LWDBs must use limited funds to subsidize as many

children as possible, to the detriment of quality improvement

incentives.

The Workforce Solutions Board for the Heart of Texas is

responsible for setting child care subsidy rates in McLennan

County. In February 2009, the Heart of Texas Board approved

reimbursement rate increases for all three types of regulated

care: licensed centers, licensed homes and registered homes. This

increase helped bring local reimbursement rates closer to the

current market rates charged by local child care providers.

The federal government recommends, but does not mandate,

reimbursement rates be set at the 75th percentile of current

market rates.ii For example, federal recommendations suggest

that a community with a $40.00 per day market rate be

reimbursed up to $30.00 per day. However, LWDB

reimbursements are set below the federal recommendations for

reimbursement. Figure 2.8.2 illustrates the difference between

the new maximum daily rates and the 75th percentile of Heart of

Texas market rates. For all ages of children in McLennan County

child care settings, the new maximum reimbursement rates are

close to the recommended 75th percentile of market rates.

The Heart of Texas Workforce Development Board has set the

daily maximum reimbursement rate at $19.34. In comparison,

the Texas average is $20.50 per day. While LWDBs in Austin, San

Antonio and Fort Worth have set higher maximum rates, these

cities also have higher costs of living and market rates. The Heart


Page 139

of Texas LWDB currently has set the maximum reimbursement

rates $3.17 below the 75th percentile. In comparison, the state

average for the maximum reimbursement rate is $8.40 below the

75th percentile. In some areas where higher reimbursement rates

are paid, such as Fort Worth, the difference may be as high as

$18.00. Additionally, of the 28 LWDBs across Texas, only 4 have

set their maximum rates closer to the 75th percentile of local

market rates than the Heart of Texas LWDB.

The inability of low and middle‐income families to afford child

care services creates a situation where the parents must decide to

accept a lower quality, higher risk child care arrangement or stay

at home with their child. This situation propagates the cycle of

poverty because the parent is unable to maintain gainful

employment or pursue education opportunities. This is an

especially difficult situation for families whose income is slightly

above the maximum allowable income for eligibility for assistance

with child care costs.

Figure 2.8.2 Comparison of Heart of Texas Local Workforce Development Board (LWDB) Established Maximum Child Care Subsidy Reimbursement Rates against Federally Suggested Reimbursement Rates (75% of Market Rate) for Licensed Child Care Centers Source: TWC. (2007). Child Care Development and Fund Plan for Texas FFY 2008 – 2009.

$0.00

$5.00

$10.00

$15.00

$20.00

$25.00

Infant Toddler Preschool School Age

Maximum Rates

75th Percentile


Page 140

Key Points to Consider

Child care costs for a family can run into thousands of dollars each year, putting child care out of reach for many low and middle income families.

Eligibility for subsidized child care is based upon family income as a percentage of the state median income (SMI).

Each of 28 statewide Local Workforce Development Boards (LWDBs) of the Texas Workforce Commission establishes local subsidy rates.

The federal government recommends that LWDB reimbursements be set at

75% of the local market rate.

i Sabo, J. (2002). The Texas Child Care Experience Since 1996: Implications for Federal and State Policy. ii Schulman, K. (2007). State Child Care Assistance Policies 2007: Some Steps Forward, More Progress Needed.


Page 141

Head Start Programs Head Start was authorized by President Lyndon Johnson as

part of the Economic Opportunity Act of 1964.i A single line

item in the act gave broad powers to the Office of Economic

Opportunity, the original home of the program. In 1965 Project

Head Start, an eight‐week summer program, was launched in

an effort to help end poverty. The following year it was

authorized by Congress as a fully‐funded year‐round program.

In 1981, the Head Start Act was passed by Congress.

Today, Head Start is a program within the Administration for

Children and Families (ACF) in the Department of Health and

Human Services. Its companion program, the Early Head Start

program for children from birth to three years of age was

started in 1995.

These programs provide early education services to

economically disadvantaged children and families. The

program’s main goal is to promote school readiness by

teaching families about the critical role parental involvement

plays in a child’s education. Head Start programs also offer

educational, health, nutrition and other services to children

and their families. Early Head Start is a similar program that

serves infants, toddlers, and their families by promoting

healthy prenatal outcomes and family involvement. While

Head Start serves children from birth to age 5, the majority of

children in Head Start (87%) are 3 and 4 years old.ii

Unlike pre‐kindergarten programs, which are predominantly

offered through public schools, Head Start services are offered

through a variety of providers. Local public, non‐profit or for‐

profit agencies apply to the Head Start program for grant funds

to open independent Head Start centers.

Section 2 . 9

Head

Sta

rt P

rogr

ams


Page 142

Children in Head Start also receive medical and dental services,

while parents can attend classes on parenting or job training. For

example, one Head Start standard requires that all children

receive a comprehensive medical screening within 45 days of

enrollment. In 2005, 89% of all children enrolled in Head Start

programs across the country received this screening. Head Start

staff are also required to assist parents in accessing continuing

medical and dental services. In the same year, 92% of all Head

Start students had continuing medical and dental services.

In 2007, 67,630 Texas children received Head Start services.iii

McLennan County Head Start providers receive funds for 953

children, including 873 spaces for Head Start and 80 spaces for

Early Head Start.iv The number of McLennan County children

enrolled in Head Start has remained steady since 2002. Currently,

12 local agencies provide Head Start services in McLennan

County, 10 of which are in the city of Waco. Further, because

accessibility to Head Start programs is important to many low

income families for numerous services beyond early care and

education, location and accessibility are critical. Figure 2.9.1

details the locations of all 12 Head Start providers and their

proximity to major roadways and public transportation routes.

The income requirement for Head Start is based on 100% of the

Federal Poverty Level (FPL), or an annual income of $22,050 for a

family of four. It stands to reason, then, that many eligible

families may require public transportation to attend Head Start.

Without reliable transportation, whether personal or public,

families face barriers to the range of vital services offered by Head

Start. In McLennan County, 10 of the 12 Head Start centers are

located in the Waco area, and 9 centers are on or near bus routes.

Head Start program capacity in McLennan County can currently

accommodate less than 1,000 children from low income families.

For these children, this may be the only opportunity for a

structured early childhood educational experience. Other options

exist in McLennan County. However, many factors put access to

the other services out of reach. In the next section, this report


Page 143

will look at other early childhood education options and the pre‐

kindergarten services of McLennan County.

Figure 2.9.1 Spatial Representation of Head Start Center Locations in McLennan County Source: US Department of Health and Human Services, Administration for Children and Families.


Page 144

Key Points to Consider The Head Start Program was authorized by the Economic Opportunity Act of

1964 and signed into law by President Lyndon Johnson.

Head Start is administered under the United States Department of Health & Human Services, Administration for Children and Families.

Head Start offers educational, health, nutritional and other services to

67,630 Texas residents, primarily ages 3 and 4.

McLennan County receives Head Start funds for 953 children; 873 Head Start (4 yr olds) and 80 Early Head Start (3 yr olds, infants and toddlers).

There are 12 Head Start Centers in McLennan County.

9 of the 12 Head Start facilities are established in proximity to local bus lines of the Waco Transit System.

Eligibility is based upon family income at 100% of the federal poverty level.

i Pub.L. 88-452, 78 Stat. 508, 42 U.S.C. § 2701 ii U.S. Department of Health and Human Services, (2009). Administration of Children and Families. iii Ibid. iv EOAC Head Start & Early Head Start. (2009). Child Development Programs Serving Children and Families.


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Pre Kindergarten In Texas, pre‐kindergarten is offered to children of eligible

families through the public school system on a half‐day basis.

State law mandates that school districts must offer half‐day

pre‐k services when at least 15 eligible children are in need of

services within the district. Eligibility criteria include low‐

income families, homeless children, English Language Learners,

children of active military and those under the care of the

Texas foster care system. While the state offers a minimum of

half‐day services, extra funding is available for selected Texas

districts to offer full‐day programs. School districts may apply

to the Pre‐kindergarten Early Start Grant Program for the extra

funding to expand their pre‐k programs to offer full‐day

services.

Section 2 . 10

Pre

Kind

erga

rten


Page 146

Approximately 200,500 Texas students were enrolled in public

school pre‐k programs in 2008‐2009i; approximately 50% of the

eligible four year olds in Texas.ii In McLennan County, 1,675

students were enrolled in public school pre‐k in the 2008‐2009

school year, with 950 (57%) of those students enrolled in Waco

ISD. An additional 146 children in McLennan County, from birth

to age 5, received other early intervention services through the

public school systems. These programs include students between

3 and 5 who have not been placed in pre‐k or Kindergarten.

These children may not qualify for pre‐k, but receive special

education services on a part‐time basis. These services include

the Preschool Program for Children with Disabilities (PPCD), and

other special education services. Head Start, which is federally

funded, is also included in this category.

Of the 18 school districts

in McLennan County, 14

offer pre‐k services to

children of eligible

families. Among the 14

districts offering these

services, 10 provide full‐

day programs; the rest,

half‐day services. Across

the county,

approximately 70% of

pre‐k students are

enrolled in full day

programs, with 30% in

half day pre‐k

programs.iii

Figure 2.10.1 Pre‐Kindergarten Enrollment Percentages of 4 Year Olds in the State of Texas and McLennan County Data source: Annie E. Casey Foundation. Kids Count Data Center. Texas. (2006).

10%

15%

20%

25%

30%

2002 2003 2004 2005 2006McLennan County Pre‐k Enrollment

Texas Average Pre‐k Enrollment


Page 147

Figure 2.10.2 Changes in Child Population for McLennan County (2002‐2006)

Source: Annie E. Casey Foundation. Kids Count Data Center. Texas. (2006)

6,000

10,000

14,000

18,000

22,000

2002 2003 2004 2005 2006

Number of Children

Year

Child Population Ages 0‐5 Child Population Ages 6‐11

Child Population Ages 12‐14 Child Population Ages 15‐17

Since 2002, McLennan County has seen an increase in the

percentage of eligible 4 year old enrollments in pre‐Kindergarten

programs (Figure 2.10.1). The increases peaked in 2005 in

McLennan County when enrollments jumped 4.4% between 2004

and 2005. The increase was followed by a 0.6% decrease the

following year (2006).

Between 2002 and 2006, the

number of children ages 0 to 5

has grown in McLennan County.

Figure 2.10.2 details the

changes in the child population

for McLennan County’s multiple

age groups between 2002 and

2006. The 2005 increase in pre‐

k students implies that while

the young population of the

county has grown, the number

of available spaces in pre‐k

programs has also increased,

allowing more eligible children

to receive pre‐k services.

The location of established pre‐

k programs in McLennan County

and the city of Waco are

detailed in figure 2.10.3. The

largest number of programs are

offered within the city limits coinciding with the greatest

population density. Outside of Waco, the remaining programs are

largely located West and Northeast of Waco.

During the 2009‐2010 school year, a new pre‐k program opened

in Hewitt, indicative of the growing 0 to 5 population and demand

for pre‐k services.


Page 148

Figure 2.10.3 GIS Representation of Public School Pre‐Kindergarten Programs in McLennan County (2008) Source: Texas Education Agency


Page 149

Key Points to Consider

Eligibility for public school pre‐k is available to children from low income and military families, English as a Second Language, homeless and the physically challenged.

200,520 Texas students are enrolled in pre‐k programs representing approximately 50% of the four year old age group.

In McLennan County, 1,675 students were enrolled in public school pre‐k during the 2008‐2009 school year.

950 of the 1,675 pre‐k students were enrolled in Waco ISD.

14 of the 18 school districts In McLennan County offer pre‐k services to children of eligible families.

Since 2004, McLennan County has witnessed a growth in the percentage of

4 year olds enrolled in pre‐k programs.


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i Texas Education Agency, State Enrollment Report 2008‐2009. Available at

http://ritter.tea.state.tx.us/cgi/sas/broker?_service=marykay&_program=adhoc.addispatch.sas&major=st&minor=e&endyear=09&linespg=60&charsln=120&format=W&selsumm=ss&key=TYPE+HERE&grouping=g

ii Annie E. Casey Foundation. (2006). Kids Count Data Center. Texas. iii Region 12 Education Service Center (2009). Open records request.