THRIVE Indicators Review Webinar: 1/10/08 · THRIVE Indicators Review Webinar: 1/10/08 6 State indicator development Ensure appropriate aggregation or disaggregation by age, race/ethnicity,

THRIVE Indicators Review Webinar: 1/10/08

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THRIVE Indicator Review

Leslie L. Davidson, Nancy Bruning, Suzanne Theberge, Jane Knitzer,

Kay Johnson

www.nccp.org

Results Based Evaluation and Indicators

Outcome (Result desired/not desired)

– Can be an indicator

Indicators of risk, process, program

– measures the risk/resilience in the population

– measures the achievement towards an outcome

– measure the process/programs to achieve the outcome (Process measure)

www.nccp.org

THRIVE INDICATOR REVIEW

Designed to assist states in determining their unique indicator set

To facilitate the potential to compare to national, state, and local indicators

Set in a results-based evaluation framework

www.nccp.org

Indicator: (using Friedman Terminology)

Available (Data Power) and

Measurable (Data Power)

Meaningful (Communication Power)

Important (Proxy Power)

Can be tracked over time and in comparisons: Federal, State, Local

Can be developed (Data Development)

www.nccp.org

Choosing Indicators: Friedman WorksheetOutcome or Result__________________________________

Candidate Indicators CommunicationPower

ProxyPower

DataPower

H M L ?

HMeasure 1

Measure 2

Measure 3 HDataDevelopmentAgenda

Children ready to succeed in school

H M L ? H M L ?

H HH L

www.nccp.org

Methods used in Review

Reviewed possible national indicator sets

Created matrix based on the Friedman Indicator structure and state utilization

Entered all indicators from national sets and from State plans in their ECCS proposals (200+)

Consolidated and reviewed potential for indicators relevant to the ECCS programs

Suggesting 32 for fuller discussion with States

Gaps still exist


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www.nccp.org

National Indicator Sets

MCHB

Institute of Medicine

National School Readiness Initiative

Kids Count (ten indicators)

Federal Interagency Forum on Child and Family Statistics

Proposed additions from NCCP/THRIVE

www.nccp.org

MCHB Indicators

MCHB: indicators states are required to collect

18 national performance measures, 6 national outcome measures, and seven health systems capacity measures

Many outcomes are mortality measures

Few health care problems short of mortality

None re health care access, medical home, school readiness, parenting domain

Include children with special health care needshttps://perfdata.hrsa.gov/mchb/mchreports/Search/core/measureindicatemenu.asp

www.nccp.org

IOM

Very large number of indicators….not geared around what is available

Focused on national rather than state

Not geared at early childhood (birth to five)

Multimodal domains: environment, economic, nutrition, general health

Ongoing progress not measured

Institute of Medicine: Children’s Health: The Nation’s Wealth, 2004

www.nccp.org

National School Readiness Indicators (23 core)

17 states participated – focused at state level

Includes process and systems indicators

Includes relevant outcome measures

Some available by state, some need extensive data development

None cover ECCS parenting domain

Multilevel approach

Ongoing progress not monitoredGetting Ready: Findings from the National School Readiness Indicators

Initiative. Rhode Island Kids Count, Feb 2005

www.nccp.org

Kids Count (ten key indicators)

Include state data over time

Include measures of risk (poverty, single parent, low birthweight, teen birthrate)

Include mortality (infant, child, teen)

Includes distal outcome measures for early childhood

– School dropout, teens out of school without jobs

No proximal outcomes

2006 Kids Count Data Book, Annie E. Casey Foundation

www.nccp.org

Federal Interagency Forum on Child and Family Statistics

Include risk measures (single mothers, teen births)

Includes outcome measures

Focused on national, not state level

– Relies on repeated national survey data

• NHANES, NHIS etc.

Multi-domain approach (family, economy, environment, education and health)

Focused more on youth and children as a whole rather than on early childhood

Ongoing tracking present

America’s Children: Key National Indicators of Well Being 2007. Federal Interagency Forum on Child Health and Family Statistics


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www.nccp.org

School Readiness Domains

Physical Wellbeing and Motor Development

Social and Emotional Development

Approaches to Learning

Language Development

Cognition and General Knowledge

www.nccp.org

System,Program,

andProcess

IndicatorsChild care

quality rating

Child care subsidies Medical homeHealth coverage

Annual dental visitsbeginning at early age

Early Head Start BreastfeedingImmunization

High BMI forchildren 2-5 in WIC

Accredited child care centersand family child care homes

Elevated blood lead level

EPSDT screening (comprehensive well-child exam) in a year

Substantiated cases of child abuse and neglect

Maternal depressionscreening

Infants & toddlers abusedand neglected referred toPart C Early Intervention

Enrollment in Part BPreschool Special Education

No more than two out-of-home placements in a

24-month period

Children with special health care needs(CSHCN) receive coordinated, ongoing,

comprehensive care within a medical home

Expulsion from early care and education due tobehavioral problems

Teachers with bachelor's degreeand training in early childhood

Hospitalizationfor asthma

Prepared by Project THRIVE at NCCP January 2008

Result: Children healthy and ready to succeed in the early school years.

Percent of children beginning school with undetected developmental

delays or chronic health problems

Percent of children demon- strating school readiness in all five domains of development

Percent of children reading proficiently

in grade 3 or 4

Using Indicators in a Results-based Accountability Framework for State Early Childhood Comprehensive Systems

Overall Outcomes

Poverty and extreme poverty

Birth to a teen motherages 15-17Low birthweight

Population risk

factorsBirth to a mother receiving

late or no prenatal careNon-white

race/ethnicity

Developmental andmental health screening

3-4 year olds in pre-K,Head Start, etc.

Health / mental health consultation in child care

www.nccp.org www.nccp.org

Overarching outcome measures

YesReadiness all five areas

YesCommonwealthUndiagnosed delays or health problems at kindergarten

YesYesSchool ReadinessReading proficiency at 4th grade

50 State data

exist

ECCS in one or more state

Recommended byIndicator


Population Based Risk Factors

YesYesMCHB, ReadinessBirths under 2500 grams (5.5 pounds)

YesMCHB, ReadinessBirths to mothers with late or no prenatal care

YesYesMCHBBirths to teens

YesYesIOM, NCCP, ReadinessPoverty below federal poverty level

YesIOM, NCCPExtreme Poverty (below 50% of federal poverty level)

YesYesNCCPChildren non white

YesYesNCCP/THRIVEMultiple risk factors

50 State data

available

ECCS: one or more state

Recommended

by

Indicator


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Health and Medical Home

YesYesMCHBBMI equal or over the 85th

percentile (those on WIC)

YesYesIOMDental Care in previous year

YesYesMCHBCompleted Immunization Schedule (19-36 mos)

YesYesMCHB, NCCPToddlers with at least one EPSDT Periodic Screen

IOMMedical Homes

YesYesMCHB, NCCP, Readiness,

No health insurance

50 State data

available


Recommended

ByIndicator

www.nccp.org

More Health Indicators

YesMCHBBreast feeding at 6 months

YesDevelopment and behavioral screenings (under 6 years)

YesYesReadinessBlood lead at or above 10 micrograms/deciliter

YesYesMCHBHospitalizations for asthma in (under 5 years)

50 State data

available


Recommended

by

Indicator

www.nccp.org

Special Needs Measures

?YesMCHBMedical Home for children with special needs (0-6 years)

YesYesNCCPEnrollment in early childhood Part B special education programs (3-5 years)

?YesIOM, NCCPSubstantiated cases abuse & neglect referred to Part C (birth to three years)

YesYesNCCPPart C Early Intervention Services (birth to three years)

50 State data

available


Recommended

by

Indicator

www.nccp.org

Social-emotional development and Mental Health Indicators

YesMothers screened (1) and (2) referred for depression

YesExpelled from child or preschools due to behavior problems (0-5)

YesYesReadinessOver two out-of-home placements in 24 months (0-6)

YesYesIOM, ReadinessSubstantiated cases child abuse and neglect (0-6)

50 State data

available


Recommended

by

Indicator

www.nccp.org

Early Care and Education Indicators (1)

Centers with access to ongoing health & mental health consultation

YesYesNCCP, ReadinessReceipt of child care subsidies

(0-6 years)

YesYesReadinessAttendance center based early child care % education

(3-4 years)

YesReadiness combined indicators

Attendance early care & education (high quality)

50 State data

available


Recommended

byIndicator


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www.nccp.org

Early Care and Education Indicators (2)

YesYesReadinessFamily Care Homes accredited by NAFCC (National Assoc. for Family and Child Care

YesYesReadinessCenters accredited by NAECY (National Assoc. For the Education of Young Children)

YesReadinessTeachers with Bachelors and specialization in Early Childhood

YesReadinessEnrollment Early Head Start for children in poverty (0-3)

50 State data

available


Recommended

by

Indicator

www.nccp.org

ECCS Domains and Indicators

Access to health care and medical homes

– Insurance, indicators of lack of care

Social Emotional Development and Mental Health

– Maternal depression

– Child protection and foster care

Early Care and Education

– Enrollment in Quality Child Care

Parenting Education

– ?

Family Support Services

– ?

Risk– LBW, single parent, poverty, extreme poverty, language, race/ethnicity

www.nccp.org

Key indicator challenges for states and federal government

Medical Home

Mental health and behavior domains

Parenting and family support domains

www.nccp.org

Using an indicator

Population Risk Indicators

– Modify understanding of level of outcome indicators

– May predict difficulty in accomplishing goals

– May guide states in strategies on programming

www.nccp.org

Asthma hospitalization rates

This may have meaning for states at many levels

– Environmental Exposure: diesel fumes, pesticides,

– Access to health care:

• Availability of health insurance

• Presence of a medical home

– Failure to integrate child care with health access (consultation)

– Contributing to failure to achieve readiness domains

www.nccp.org

Data development: Ready in 5 domains

Not all states have readily available, high quality data

Some states (or portions of states) require kindergarten/school entry assessments

– If standardized assessment and comparable data, state is ready to use indicator

– If not, data development is key step

• Pilot data collection efforts

• Voluntary data collection efforts

• Mandatory data collection efforts

• Statewide???


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www.nccp.org

State indicator development

Ensure appropriate aggregation or disaggregation by age, race/ethnicity, geography

Work with what is there and track it

Consider modest data development projects – prioritize proximal outcomes

Use the risk measure in interpreting the process measures

www.nccp.org

System,Program,

andProcess


quality rating













24-month period












in grade 3 or 4


Overall Outcomes



Population risk



race/ethnicity




www.nccp.org

Resources & Upcoming Events

THRIVE Indicators Discussion Forum

– www.nccp.org/forum

February Conference Call: States’ Experiences Developing Indicator Sets

– Joan Blough (MI), Bob Costantino (VT), & Deborah Nelson (NC)

– February 7th, 2008, 2:30-4:00 EST

AMCHP Presentation: The State of Play at the State Level: Findings of the Project THRIVE Indicator Review

– March 3rd, 2008, 10:45am

ECCS Annual Meeting: Indicators are key conference theme

– March 12-13th

www.nccp.org

Questions?

www.nccp.org

System,Program,

andProcess


quality rating













24-month period












in grade 3 or 4


Overall Outcomes



Population risk



race/ethnicity




For more information or questions, contact us at Project THRIVE

[email protected]

Jane Knitzer, EdD Director, National Center for Children in Poverty

Kay Johnson, MPH, EdM Project Director

Leslie Davidson, MD, MPH Senior Health Advisor [email protected] or 1-212-342-0247

Suzanne Theberge, MPH Research Analyst

System,Program,

andProcess

Indicators

Child carequality rating













24-month period












in grade 3 or 4


Overall Outcomes


Birth to a teen motherages 15-17

Low birthweight

Population risk



race/ethnicity




Exposure to multiple(3+) risk factors

Documents

THRIVE Indicators Review Webinar: 1/10/08 · THRIVE Indicators Review Webinar: 1/10/08 6 State indicator development Ensure appropriate aggregation or disaggregation by age, race/ethnicity,