Early Childhood Needs Assessment Broad findings Anne Discher

ECI Stakeholders Alliance September 10, 2013

Final project goals • Identify how well the early-childhood system is

positioned to meet the “demand” for quality services across Iowa based on current supply and capacity and estimated future “demand.”

• Recommendations to meet identified gaps in access to and the quality of services, including strategies to improve the early-childhood system.

• Highlight state and federal policies and funding impacting the provision of quality services.

• Recommend approaches for periodically updating the needs assessment.

Look in this section for

select quotes from parent focus groups that reflected consensus or

common themes among

participants.

Projected change in population under 6, 2010-20

Percent of Iowa population under age 6 by county type, 2010

Future demand – geography

Source: U.S. Census Bureau, Woods and Poole population projections

Future demand – race/ethnicity Projected change in population under 6, 2010-20

Source: U.S. Census Bureau, Woods and Poole population projections

Parents reported difficulties

finding providers who speak

languages other than English. One tried a

phone translation service, but

found it difficult. “You cannot

translate emotions over

the phone.”

LEP/ELL kindergarten students in Iowa schools as percentage of all kindergartners, 97-98 to 12-13

Iowa's 15 top school districts in terms of percent LEP enrollment in kindergarten, 2011-12:

Storm Lake (73%) Sioux City (24%) Denison (67%) Des Moines Independent (23%) Marshalltown (53%) Hampton-Dumont (23%) Perry (42%) Wapsie Valley (23%) Columbus (39%) Belmond-Klemme (23%) Postville (36%) Rock Valley (22%) West Sioux (28%) Clarke (20%) West Liberty (25%)

English Language Learners

Iowa's 15 top school districts in terms of percent LEP enrollment in kindergarten, 2001-02:

Storm Lake (69%) Albert City-Truesdale (25%) Columbus (68%) Lenox (25%) Denison (48%) Jesup (21%) West Liberty (47%) Sioux City (18%) Postville (44%) Wapello (18%) Alta (31%) CAL Community (17%) Perry (28%) Wapsie Valley (15%) Marshalltown (28%)

Source: Iowa Dept. of Education

What young children need Looking ahead, we know all young children will have the same essential needs for healthy development and for success in school and beyond (four ovals): • Broad array of health care services to identify and respond to

illness, injury and other health needs (Health and nutrition) • Consistent nurturing and support in a household that meets

their basic needs as they explore the world (Family Support) • Early response to special conditions requiring professional

attention, in environments that support inclusion (Special Needs).

• Supervision in enriching, developmentally appropriate environments when not with their families (Early Learning)

Health and nutrition • Child-health practitioners are as close to a

universal source of contact with a professional as Iowa children have before they enter the education system.

– 95 percent of young children in Iowa see a health practitioner for preventive care (Child and Adolescent Health Measurement Initiative, National Survey of Children’s Health, 2007.)

• Iowa is a national leader in covering children. – Between Medicaid, hawk-i and private insurance, over 95 percent

of all young children are covered. Safety-net providers (FQHCs, rural health centers) provide some services to others without coverage.

Public health insurance • Medicaid is a significant access point for families,

serving around half of all young Iowa children and an even higher share of low-income children.

– Iowa rates of well-child care through EPSDT are higher than U.S. average, but 15 to 20 percent of eligible children are not receiving even one recommended well-child visits during the year.

– Medicaid enrollment drops as age increases; there’s a large drop off after age 1 (when income eligibility is higher) and a steady decline thereafter, as family incomes slowly increase, on average.

• Hawk-i is an important health resource for children in families with slightly higher incomes, but serves a very low share of children (13 percent) who are eligible based on income.

• Neither is an option for undocumented children.

Families reported serious

challenges finding

providers who will accept Medicaid,

particularly specialists,

dentists and opticians.

Because of low

Title XIX reimbursement

rates, “We don’t get same quality of care for ourselves that someone with private

insurance would get.”

Access to health care

• Availability across Iowa – Family practice and well-child care fairly equally available

across the state – Specialty care – including pediatricians and dentists – is

strongly tilted toward major cities

• Families traveling distances to see providers need special support to manage logistics.

“Reimbursement has to be better to support more doctors in rural

areas.”

Developmental screening • Primary-care participation is high, but fewer young

children have medical home or receive developmental screening. Moving to address developmental and social determinants of health next step.

• Need is significant. – More than one in five Iowa children four months to 5 years are at

moderate or high risk of developmental, behavioral or social delays (CAHMI, 2007). Among those at risk for developmental delays, only 50 percent are detected prior to school entry, when early intervention has the greatest impact (CDC).

• Health providers are key partners in early identification. – 33% —> 93% Share of 1st Five health providers in Iowa including

developmental surveillance or screening before and after 1st Five involvement (CFPC, Summary of Evaluation Findings: 1st Five Healthy Mental Development Initiative, January 2013)

Family support & special needs • Family stress and early-childhood adversity can profoundly

harm healthy development. • There are families in Iowa facing significant stresses and

struggling to provide consistent, enriching environments for their children.

– Nearly half of all young children live in families with incomes below 200 percent of poverty; nearly 20 percent live in families with incomes below 100 percent of poverty

– One-quarter of mothers of young children have high-school diploma or less – One-third of births are to single women.

• These are also families for whom home visiting and family-support programs and resources are generally focused and most beneficial.

• Iowa has made significant gains in this area.

“The mental health

shortage is huge in the state. If we

need anything, we have to go way far -- to

Council Bluffs. That’s 45

minutes away. We can’t afford it.”

All in Iowa Served by family

support program Percentage

Children 0-5 242,345 24,180 10.0%

Mothers of children 0-5 with H.S. or less 40,510 9,237 22.8%

Add slide of program use by co type …

Share of Iowa families with young children served by family-support program, 2012

13,764 families served Source: Iowa Dept. of Public Health

Family support

Services for special needs • A special need, whether behavioral, developmental, or

physical, not only requires its special care, but also places additional strains on parents.

• There are opportunities in Iowa to better meet the needs of children and families.

– Children with very substantial conditions likely to require ongoing attention (nationally, an estimated 3 percent to 5 percent of children) are typically identified and receive services.

– Children with less severe needs, however, are less likely to be served – even though there are programs (Parts C and B of IDEA for children with disabilities, and a variety of mental-health services through private insurance and Medicaid) designed to serve them.

“We are dealing with doctors all

around the state. Who coordinates

that? The parents. It’s a big barrier to quality

services and really hard on us

as a family.”

Percent of children ages 0-3 receiving Part C services, 2012-13

3,502 Iowa children received Part C services

19% -- birth to 1 32% -- 1 to 2 50% -- 2 to 3

Early care and education • Can and should serve two functions:

– Safe and affordable substitute care when parents are working or in school – Developmentally appropriate settings to promote learning and

development. Even when parents do not need substitute care, children benefit from high quality early-learning experiences with other children and adults.

• Iowa’s economic growth over the last 50 years is in significant part due to increasing number of women in the workforce, with Iowa leading the nation in the proportion of families with young children where both/only parents work (74 percent).

• Most Iowa families (at least up to and often even well above 200 percent of poverty) struggle to find and afford high-quality care.

• This is another major area of opportunity in Iowa.

Number of child care and preschool slots tallied by CCR&Rs, by program type

*Family, Friend & Neighbor Care Only a small share of FFN care shows up in Iowa datasets, but we know some things about it from national studies: • It is the most common form of non-parental care in the U.S. Estimated

share of children under 5 with employed parents using FFN care ranges from 33 percent to 53 percent.

• Infants and toddlers are most likely to be in FFN care as their only non-parental source of care; preschoolers are more likely to use multiple care arrangements that include FFN.

• Families across all socioeconomic groups rely on FFN care, although families with low-incomes are most likely to use it.

• FFN caregivers are most commonly relatives. Relative or not, they are often of the same ethnic background and have similar incomes as the children for whom they are caring.

Susman-Stillman, Amy and Patti Banghart. (Aug. 2008). Reviews of Research Research Brief: Demographics of Family, Friend, and Neighbor Child Care in the United States. Research Connections.

“We need to support FFN

care. Sometimes

that is best for the child.

Please subsidize this

care. “

Strengthening FFN care is important to healthy child development and strengthening the child-care system in Iowa.

Quality • Significant gaps in quality exist among Iowa’s child-care

providers. Although the state operates quality improvement initiatives and there are stellar programs that lay a solid foundation for children, too many parents cannot find – or cannot afford – care that supports their child’s development.

• Regulations and information about the quality of care (e.g. QRS) are critical, but alone will not make high-quality care affordable and available – it also requires additional public-sector support and financing.

“In our county, we have one

day care that’s really good.

It’s big, but it’s always full.”

Families were able to

describe elements of quality care. “They sent

home a lot of information.

They talked to us about our

son.”

Percent of children 0-5 in NAEYC accredited centers and preschools

Statewide, there are also seven home providers accredited by the National Association for Family Child Care (NAFCC).

Statewide, XXXX providers

participate in QRS

Put in pie charts for homes and centers

Number of licensed or registered providers

QRS-participating child development homes or centers by QRS level, 2012

Centers

Child development homes

Source: Iowa Department of Human Services

N= 532 542 total licensed centers

N= 718 1,924 total registered CDHs

Child care assistance • Child care assistance serves only a small fraction of children

(approximately 6 percent of all children 0-5 and 15 percent of low-income children) – but is a place to start in addressing the need for affordable, quality child care.

• Iowa’s child-care assistance program’s income eligibility limit of 145 percent of poverty ($32,412 for a family of four) is one of the lower in U.S.

– Iowa families whose income rises even slightly above that actually find themselves worse off – “cliff effect”

• Iowa has made gains in reimbursement to providers under CCA, but there is more to be done.

– Even after modest increases in the last two years, the state’s payments to child-care providers are below national recommendations.

– Providers face a choice: take fewer children on CCA to increase revenue or serve children on CCA and defer wage increases, capital and equipment improvements, etc.

“I wasn’t making

enough hours at work, and I lost my child care, which is partly why I

had to pull her from the center.”

“I am trying to

find [a provider] for

second shift … that takes the subsidy. There

is nobody. “

Availability • Nearly 1/3 of those seeking assistance from CCR&R

are looking for care during nontraditional hours, and over a quarter are seeking infant care—both types of care that can be difficult to find and to afford.

“I worked a lot of weird hours – I worked till midnight a lot of nights, but

the center was only open till

10.”

Ages 0-2 Ages 3-5

Children served by child care subsidies 4,521 11,267 Children in families under 200% of poverty 48,425 52,018 Percent of children served 9.3% 21.7%

Sources: Iowa Dept. of Human Services and U.S. Census Bureau

Young children serviced by child care assistance by age

Preschool • Iowa has expanded preschool dramatically over last six years,

but growth has been uneven – geography – participation by special needs and race/ethnicity

• Iowa has multiple programs that serve somewhat different functions, but there is not an organized way of looking at them at the state level.

• Limits of state data make difficult a full understanding of the preschool landscape in Iowa.

• U.S. Census data tells us two-thirds of four-year-olds have some type of preschool experience, but parent reports reflect a wide range of experiences in terms of quality and amount.

• Administrative data offers greater information about the type and quality of care.

Said one Head Start

administrator: “We have

problems on administrative

end. It’s hard to keep teachers. Why work for

Head Start when you can work for

$10,000 more through the

schools?”

U.S. Census

Parent-Reported Preschool Among 4-year-olds

Preschool participation • Looking back at preschool participation among this year’s

kindergartners in SVPP, there was great variation: – Participation rates among non-FRL children were roughly 6

percentage points higher than for FRL children. – Rates were as much as 18 points higher for white students

than those in other racial and ethnic groups – ELL students also had low SVPP participation rates

• Such differences suggest greater attention needed to recruiting and enrolling low-income, minority and English-language learning students if preschool is to help “close the gap.”

Kindergartners who participated in Statewide Voluntary Preschool by group, 2012

Source: Iowa Dept. of Education

Kindergartners who participated in Shared Visions by group, 2012

Source: Iowa Dept. of Education

Iowa children in Head Start

3 year-olds

3,371*

4 year-olds

3,831*

5 year-olds

27

Total

7,229

Head Start

Iowa kids in Early Head Start

Under age 1

464

1-year-olds

478

2-year-olds

546

3-year-olds 37

Total

1,525

Source: Iowa Head Start State Collaboration Office, Iowa Dept. of Education * Includes Drake HS; other figures exclude it

Preschool & 3rd grade reading

• Children with reported preschool participation were more likely to be proficient than those without. – The difference—5 percentage points—existed

four years after the preschool experience itself.

• But there is a roughly 15-point gap between FRL and non-FRL students, whether or not they participated in preschool. – Suggests that preschool narrows, but does not

close, the gap in educational performance of low-income and higher-income children.

Percent of third-grade students proficient in reading by free and reduced-price lunch status and preschool participation

• As Iowa continues to build its early-childhood system, policy makers and advocates must focus particular attention to place. ̅ An Iowa challenge: Supporting programs and services in areas where the

young-child population is greatest while still meeting needs of families in areas with low population density.

• They also must do so in the context of the ethnicity, culture and language of the young children in those places.

• Patterns of service delivery vary: ̅ Health services—particularly specialty ones—are highly concentrated in

Iowa’s urban areas. ̅ Children in metropolitan areas are more likely to be cared for in a child-care

center versus child development home. ̅ Family-support programs tend to serve more families in higher-need

counties. ̅ Foster care placement rates are highest in the state’s regional centers.

• But with other services—Medicaid, WIC, Hawk-i—there is very little difference across counties in usage.

Place matters

• High-poverty neighborhoods – Fewer economic opportunities – poorer and older housing stock (and more environmental contaminants –

dust, mold, lead, asbestos). – far fewer play areas where parents can safely take their children, and fewer

activities when they get there. – Less time, space and opportunity to expose children to a rich array of

experiences and language.

• Each of these can be addressed, but not solely through discrete and individual services to specific children and families.

– For these places to be safe and supportive for young children, community-building activities are also needed.

• There’s no place in Iowa where there’s no opportunity to improve outcomes.

• Like rest of U.S., funding for early childhood in Iowa has traditionally lagged far behind that for school-age children.

Investment matters, too

Source: Child and Family Policy Center, Early Learning Left Out, 2013

State and Federal Programs: Child Care Tax Credit CCDBG CAC Food Program Head Start/3-4 State Preschool Part B Preschool Part C Early Intervention Early Head Start MIECHV Other State HV/EC K-12 Public Spending

Per-capita state and federal spending on young children, Midwestern states and U.S. average

Source: Child and Family Policy Center, Early Learning Left Out, 2013

Per-capita state and federal spending on children by age

• Ultimately, Iowa collects much more data about young children and its families than it has analysts to mine it.

• But it is often difficult to obtain and sometimes contradictory.

• Replication: It’s been a lot of work! • Will need prioritization, define key indicators • Service/administrative data: More investment needed

• Departmental buy in • Establish template for use each year • A group – ECI component group? – to prioritize and

interpret data • Doing so will contribute to additional analyses to answer

important policy questions, inform practice and improve results.

Data issues

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