Every Child, Every Day

Welcome to the Community Health CoalitionThe Health Improvement Plan of Washtenaw County

Carrie Rheingans, MPH, MSWCommunity Health Committee Co-ChairProject ManagerWashtenaw Health Initiative

Lily Guzmn, MPH, MSWHealth Improvement Plan CoordinatorWashtenaw County Public Health

1HIP is a county-wide partnership working to improve the communitys health

Facilitate partnerships, Collect & analyze local health data and sets health improvement objectives, Promote evidence-based strategies.

About the Health Improvement Plan2The Health Improvement Plan of Washtenaw County was established in 1995 by partners that are still at the table today Washtenaw County Public Health, St. Joseph Mercy Health System, and University of Michigan Health System.

3 pillar structure (partnerships, data, strategies) helps to sure that population health data are collected and analyzed, needs prioritized, and issues addressed collaboratively.

HIP GoalsPartnershipsGrow partnerships across sectors and disciplines.

DataCollect, analyze, and disseminate data on health factors, outcomes, and disparities in Washtenaw County.

Establish long term health objectives and monitor progress.

StrategiesIncrease understanding of evidence-based strategies.

Increase understanding of policy and environmental approaches.

Further address social determinants of health, social justice, and health equity.

Develop, implement, and monitor shared countywide health improvement plan.HIP GoalsHIP has 7 strategic goals that follow the same 3 pillar structure (partnerships, data, strategies)

Highlight focus on social determinants of health, health equity, and evidence-based strategies. 3Community Health CommitteeCoordinating TeamImplementation Team

Coalition Pa

HIP Coalitions4HIPs coalition is called the CHC. We meet quarterly. Each meeting focuses on a specific population health issue facing our county and includes:

-overview of the local data on the issue the extent of the problem, geographic regions where the problem is most prevalent, evidence-based population level approaches, opportunity to make connections and form collaborations to address specific issues.

Coordinating steering committee

Implementation working team focused on analysis of data, best practices, and networking.Funding Partners

2015 HIP Survey Funding Partners

A Behavioral Risk Factor Survey, done every 5 years, telephone (landline and cell in 2015) survey of more than 2000 adults. Partners are working over the next several months to finalize the instrument and then the vendor will be in the field collecting data by winter/spring. These partners Help fund HIP survey every 5 years and also serve on HIPs leadership teamAnn Arbor Center for Independent Living Ann Arbor Public Schools - Community Recreation & EducationAnn Arbor YMCAArea Agency on Aging 1-BBlueprint for AgingChelsea-Area Wellness FoundationCity of YpsilantiCommunity Support and Treatment Services Hemophilia Foundation of MichiganHIV/AIDS Resource CenterHylant GroupMarch of DimesMichigan Institute for Clinical and Health ResearchNational Kidney Foundation of MichiganPackard HealthRegional Alliance for Healthy Schools (RAHS) School Based Health CentersSt. Joseph Mercy Health SystemSlow Food Huron ValleySocial Security AdministrationTheRide / Ann Arbor Transportation AuthorityUnited Way of Washtenaw CountyUniversity of Michigan Comprehensive Cancer CenterUniversity of Michigan Health System University of Michigan Library - Health Sciences LibrariesWashtenaw Area Transportation StudyWashtenaw Asthma CoalitionWashtenaw County Community Support and Treatment ServicesWashtenaw County Office of Community and Economic DevelopmentWashtenaw County Parks and Recreation CommissionWashtenaw County Tobacco Reduction CoalitionWashtenaw Health PlanWashtenaw Intermediate School DistrictYpsilanti Health CoalitionHIP PartnersThese organizations have signed on as HIP Partners. Representatives stay involved through our meetings, email listserv, contributing funding, and sharing their skills and energy. 6Ann Arbor Public SchoolsAnn Arbor Public Schools-Rec & EdAnn Arbor Public Schools Pathways to SuccessAnn Arbor YMCACatholic Social Services of Washtenaw CountyCenter for Healthcare Research & TransformationCorner Health CenterGrowing HopeHemophilia Foundation of MichiganIHN @ Alpha HouseMaternal Management LLCMentor2Youth Inc.Ozone HouseProject Healthy SchoolsSlow Food Huron ValleyTask Force on At Risk YouthThe Young People's Project, University of MichiganUniversity of Michigan Health System (UMHS)UMHS Comprehensive Cancer CenterUMHS Project Healthy SchoolsUMHS Regional Allice for Healthy SchoolsUMHS Ypsilanti Health CenterUnited Way of Washtenaw CountyWashtenaw Alliance for Children and Youth (WACY)Washtenaw Area Council for Children (WACC)Washtenaw County Community Support and Treatment ServicesWashtenaw Alliance for Virtual Education (WAVE) Washtenaw Community Health OrganizationWashtenaw County Office of the SheriffWashtenaw County Office of Community & Economic DevelopmentWashtenaw County Public HealthWashtenaw County Trial CourtWashtenaw County Youth CenterWashtenaw Health PlanWashtenaw Intermediate School DistrictTodays AttendeesYou are also our partners we have a great variety of people in the room today. 7Visit our websitehttp://hip.ewashtenaw.orgJoin our email listAttend meetingsFor more informationFor more information, visit the HIP website

Local dataYear 2020 objectivesPresentations and reportsCommunity health assessment and community health improvement plan

Email list about 350 on the list

Next CHC meeting is January 13, 2015. Save the date. 8Lunch and refreshmentsSign-inRestrooms

HousekeepingLunch please help yourself to lunch and Water and coffee availableSign-in we need everyone to sign inRestrooms describe where they are9A big thank you to:Jessica Black, City of Ann Arbor Parks and RecreationMembers of the At-Risk Task ForceYou!

Meeting host: Naomi NormanExecutive Director of AchievementWashtenaw Intermediate School District

Todays Topic: Every Child, Every DayI want to start by saying that you to donors who helped make this meeting happen. RSVPs for todays meeting exceeded our expectations and we quickly realized that we would need to book a larger meeting space. J.T. Sangsland of WISD worked with Naomi Norman, our host for today to find this beautiful and larger space that would fit all those who RSVPd and also one that would accommodate the 30 youth here from:

Washtenaw Alliance for Virtual Education (WAVE) Ann Arbor Pathways to Success

Welcome to all and thank you to the following donors (see slide).

This presentation will take a look at the various data indicators that are available to tell the story of students who are struggling within Washtenaw county.

Several speakers and special guests. Ill turn the meeting over to Naomi to host todays meeting.10At-RISK Youth: A DATA PortraitWashtenaw County -- October 2014Highest performing county in Michigan?Number 1 in 8th grade math (Kids Count)Number 1 in 11th grade reading (mischooldata.org)Number 1 in 11th grade math (mischooldata.org)Half our high schools in the top 5% of all Michigan high schools (top to bottom ranking) Several of the top high schools in the country (US News and World Report)But are we the best for ALL kids?Definitions of At-riskMDE

Low achievement (levels 3 or 4) on Michigan Education Assessment Program (MEAP) tests in mathematics, reading or scienceFailure to meet core academic curricular objectives in English language arts or mathematics (applies to grade K-3 pupils only) ORVictim of child abuse/neglectPregnant or parentingEligible for free and reduced lunchAtypical behavior or attendanceFamily history of school failure, incarceration or substance abuse

Washtenaw Alliance for Children & Youth (WACY)

WACY has focused on economically disadvantaged school-aged youth in their recent shared outcomes process and defines that population by: * those who qualify for the free or reduced lunch program and/or youth from families with incomes below 185% of the federal poverty limit (FPL).

Task Force Input

Mental health issuesPhysical health issues Substance abuse Age of first CriminalJustice ContactMore than one traumatic experienceDeath of caregiver Witness violenceWitness abuse, neglect DispositionPattern of middle school failureEnglish Language LearnersAfrican American males Middle school behaviors on/off track

How many students are free and reduced lunch eligible?How many students miss 10 or more days of school? 36 days or more?What percent of students score at the lowest level on the MEAP in all tested areas?Number of homeless youth 2012-13? What percent of students reported binge drinking in the last 30 days? PredictionsIn 12-13, 28 % w/ 10+ absences63% at least one 462 % AA taking remedial coursework

1514,128Washtenaw County students eligible for free and reduced lunch in 2013-14 school year. Demographics46,797Students enrolled in Washtenaw Intermediate

School District in 2013-14.We know there is a strong correlation between income and success in typical school programs.

That is 30% of our students.

KidsCount Data16DemographicsPercentRace/Ethnicity64% White18%African American7%Asian5%Hispanic5%Two or more races1%OthersHomeless Youth1,316Number of youth served by the Education Project for Homeless Youth in 2012-13. Continuing results from the economy what are the impacts even after economy starts to rebound what about the long lasting impacts of the instability? 18Pair-ShareWhat do you consider the most important criteria for being At-risk?Academic PerformanceMEAP Math 4th Grade by Race

ACT Math Comparison by Race

ACT Math Comparison by Income

Academic Performance1,349Number of students scoring lowest level of proficiency on ALL tested subjects. That is 17% of the students who were assessed by MEAP across all grades tested. 63% scored at least one 4. Source: BAA

We know there is a correlation between academic performance and dropping out of school25African American Math Performance

482 African American 8th graders, Fall 2013280 of those also in their district in 3rd gradePair-ShareWhat is one reason some groups of kids dont perform as well as others?AttendanceThe Importance of Being in School

http://www.attendanceworks.org/http://new.every1graduates.org/wp-content/uploads/2012/05/FINALChronicAbsenteeismReport_May16.pdfResearch and data analysis shows that there is a strong correlation between attendance and achievement. The two charts here show data for different groups of students (kindergarten and high school) and the significant correlations between attendance and math and reading achievement. More can be found in the highlighted report and at the attendanceworks.org website.

29How are absence rates determined?Any absence from school or from a class periodexcused or unexcusedexamples: illness, skipping class, participating in school-sponsored activity, family vacation

Calculated as a percent present of total time possibleExample 1Student misses 2-3 days per month = 18-27 days (80-85% attendance)Example 2Student is late once a week and misses half a day = 18 days (85% attendance)Varies by district based on local policy. There is no consistent measure of attendance (Does every district count the same kinds of absences in the same way? How many minutes late do you have to be to be considered absent? How many class periods does a high school student need to miss before it is recorded as a half day absent or a full day absent? How many days does a student need to miss to be un-enrolled?)30What is chronic absence?Michigan Department of Education Missing 10 days a year or more (5% or more)

Attendanceworks.org defined as missing 10% of a school year for any reasonMissing 18 days a year (or more)

Severe chronic absence Missing 20% of the school year or moreMissing 36 days or more

On our state data website, Mischooldata.org, chronic absence is tracked at 10 days or more absence per year. Other organizations, such at the attendaceworks.org site, use 10% of the school year as the measure for chronic absence. There is also the idea that you can be severely chronically absent if you miss more than 20% of the school year. In Washtenaw County we need to carefully consider these definitions because a flat 10 days or more absence rate doesnt begin to convey the story of the complexity of our problem.31Source: MiSchoolData.orgWashtenaw County has 30% of its students who miss more than 10 days of school. This is higher than the state average of 29%. In many schools and districts the percent of students missing 10 days or more is MUCH higher.3213,981 Students in Washtenaw County missed 10 or more days in 2012-13Source: MiSchoolData.orgPercents do not convey the actual number of students. Some districts and communities are impacted to greater degrees than others due to sheer volume of students who are missing school. But all districts are impacted on some level.33Source: MSDS 2013-14 Attendance Data Washtenaw CountyThis slide uses a different definition of chronic absence. It uses 10% of the school year rather than 10 days. And we also considered the idea of severe chronic absence since that appears to be an issue for over 2000 students in our county.34Who is missing school?Which subgroups of students are impacted most?

Average White student in Washtenaw County attends 171 days of school

Average Black student attends 160 days of schoolSource: MSDS 2013-14 Attendance Data Washtenaw County2013-14 data35Source: MSDS 2013-14 Attendance Data Washtenaw CountyNormalized across districts to 180 daysOnly includes local districts and ISD students. Does not include charter schools.SNE=Supplemental Nutrition Enrollment (free and reduce lunch eligible)LEP=Limited English Proficiency The difference between white/Asian and black is 11 days of school a year. Multiply that by 13 years of school and you have 141 day difference. That is two months shy of one year of schooling. At 160 days, black students lose 20 days a year of schooling. Multiply that by 13 years and it is at least one year of education. A few days difference is a HUGE difference in learning opportunity.36Suspension Patterns for Students with IEPs (Special Education)Type of Disciplinary ConsequenceStudents with IEPs in Washtenaw County2013-14

Approximately 6,100 students with disabilities with 1400 discipline consequences1037 out-of-school suspensions352 in school suspensions11 expulsionsSource: MSDS 2013-14 Discipline Data Washtenaw CountyShifting to discipline data, the only data reported formally is the discipline data for students with IEPs (those receiving special education services). If we look only at this group of students, the impact of out of school suspension is startling. There are approximately 6,100 students with IEPs in this data set. There were 1400 disciplinary consequences related to suspension or expulsion. Most of the suspensions were out of school.37Source: MSDS 2013-14 Discipline Data Washtenaw CountyCounty AverageLooking at the out of school suspensions, districts range from suspension averages that range from one day to eight days. Each of the 9 districts plus WISD is represented here. The bottom line represents the county average.38In Washtenaw County 2013-14:1037 out of school suspensions for an average of 3.6 days each

3743 days of school missed

Source: MSDS 2013-14 Discipline Data Washtenaw CountyThis is for students with disabilities. We do not have data for all other student groups.39For More InformationAttendance Works: http://www.attendanceworks.org/ Chronic Absenteeism Report: http://new.every1graduates.org/wp-content/uploads/2012/05/FINALChronicAbsenteeismReport_May16.pdfAttendance data for all districts and schools in Michigan: http://mischooldata.org

For more information about this presentation and its data, please contact: Naomi Norman, Washtenaw ISD, nnorman@washtenawisd.org, 734-994-8100 ext. 1263Pair-ShareWhat is one reason that students miss school that you feel we can address?Depression / SuicidalityKnow the Risks:Increase Hope

Adreanne Waller, MPH, Epidemiologist/Health AnalystWashtenaw County Public HealthMarch 2013

43Outline Interventions that WorkAdverse Childhood ExperiencesMortalityBehaviors/RisksEmergency Department Admissions HighlightsConnection between needs, interventions and data?

Adreanne Waller, MPH - Washtenaw County Public HealthAdreanne Waller, MPH - Washtenaw County Public Health

Mental Health PromotionFor Whole PopulationThose Who Have Already Been Affected By Suicide or Suicidal BehaviorsPersons With Risk FactorsLike DepressionAdreanne Waller, MPH - Washtenaw County Public Health

Mental Health PromotionFor Whole PopulationThose Who Have Already Been Affected By Suicide or Suicidal BehaviorsPersons With Risk FactorsLike DepressionWhat risk groups?

Are we addressing?Opportunities for intervention?

Other or different data needed?National StrategiesSAMHSAAdreanne Waller, MPH - Washtenaw County Public Health

Create supportive environments that promote healthy and empowered Individuals, families, and communities Enhance clinical and community preventive services Promote the availability of timely treatment and support services Improve suicide prevention surveillance collection, research, and evaluation National Strategy for Suicide Prevention GOALSBased on 6/1 version of NSSP. Please do NOT distribute any portion of this presentation.48The truth about childhood is stored up in our bodies and lives in the depths of our souls. Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions shamed and confused, our bodies tricked with medication, but our soul never forgets. And because we are one, one whole soul in one body, someday our body will present its bill.Alice MillerAdreanne Waller, MPH - Washtenaw County Public HealthAdreanne Waller, MPH - Washtenaw County Public Health

Preventing poor mental health in adolescents and teenagers has lifetime benefits.Adreanne Waller, MPH - Washtenaw County Public HealthAdverse Childhood ExperiencesAdverse Childhood ExperiencesSocial, Emotional, & Cognitive ImpairmentAdoption ofHealth-risk BehaviorsDisease, DisabilityEarlyEarlyDeathDeathThe Influence of AdverseChildhood Experiences Throughout Life

Death

BirthAdreanne Waller, MPH - Washtenaw County Public HealthThis slide is titled the influence of adverse childhood experiences throughout life and contains a pyramid of five levels from birth, at the bottom of the pyramid, to death, at the top of the pyramid.

The first level at the base of the pyramid is labeled adverse childhood experiences.

The next level up is labeled social, emotional, and cognitive impairment.

The next level up is labeled adoption of health-risk behaviors.

The next level up is labeled disease, disability.

The last level, at the tip of the pyramid, is labeled early death.

Adreanne Waller, MPH - Washtenaw County Public HealthThis slide shows positron emission tomography (PET) scan graphics of the temporal lobes in a healthy and abused brain.

Healthy brain: this PET scan of the brain of a normal child shows regions of high (shown in red) and low (shown in blue and black) activity. At birth, only primitive structures such as the brain stem (in the center of the brain graphic) are fully functional; in regions like the temporal lobes (at the top of the graphic), early childhood experiences wire the circuits.

Abused brain: this PET scan of the brain of a Romanian orphan, who was institutionalized shortly after birth, shows the effect of extreme deprivation in infancy. The temporal lobes (at the top of the graphic), which regulate emotions and receive input from the senses, are nearly quiescent. Such children suffer emotional and cognitive problems.

Some say depression is genetic.Some say depression is due to a chemical imbalance.

Vincent J. Felitti, M.D.Robert F. Anda, M.D.Might depression be a normal response toabnormal life experiences?

Vincent J. Felitti, M.D.Robert F. Anda, M.D.Childhood Experiences Underlie Chronic DepressionAdreanne Waller, MPH - Washtenaw County Public HealthVincent J. Felitti, M.D.Robert F. Anda, M.D.This slide contains a bar graph titled childhood experiences underlie chronic depression with statistics on the percentage of women and men with a lifetime history of depression.

ACE ScorePercentage of WomenPercentage of Men018 11124192352534230Greater than or equal to 45835Childhood Experiences Underlie Suicide12034+Adreanne Waller, MPH - Washtenaw County Public HealthVincent J. Felitti, M.D.Robert F. Anda, M.D.This slide contains a bar graph titled childhood experiences underlie suicide and presents ACE scores and the percentage of people attempting suicide.

ACE ScorePercent attempting suicide01.412.624.8310.74 or more19.3Estimates of the Population Attributable Risk*of ACEs for Selected Outcomes in Women

*That portion of a condition attributable to specific risk factorsVincent J. Felitti, M.D.Robert F. Anda, M.D.Prevention is important for more than physical healthMental health is tightly linked to physical healthAdreanne Waller, MPH - Washtenaw County Public Health

Suicide attempt monitoring, as well as other related measures, help us to take the ten thousand mile view regarding what groups are at highest risk and where interventions may be most needed.

MortalityAdreanne Waller, MPH - Washtenaw County Public HealthDeaths Due to SuicideWashtenaw County Residents By Age Group 2000-2012Source: Michigan Department of Community Health and Washtenaw County Public HealthWaller, A. suicidetrendsbyage.pptx 7/8/14Risk Factors/BehaviorsYOUTHAdreanne Waller, MPH - Washtenaw County Public HealthAdreanne Waller, MPH - Washtenaw County Public HealthNational 16% of high school students Considering or attempting suicide is often indicative of serious mental health problems, and may signal other traumatic life events such as physical or sexual abuse. Youth are much more likely to think about and attempt suicide if they are depressed.2 Other risk factors for suicide include co-occurring substance or alcohol abuse and mental disorders; a family history of suicide; physical illness; relational, social, work, or financial loss; and easy access to lethal methods, especially guns.3 Finally, youth who have experienced stressful life events, who have poor levels of communication with their parents, and who have been exposed to the suicidal behaviors of others are more likely to commit suicide64Adreanne Waller, MPH - Washtenaw County Public HealthNational 16% of high school students Considering or attempting suicide is often indicative of serious mental health problems, and may signal other traumatic life events such as physical or sexual abuse. Youth are much more likely to think about and attempt suicide if they are depressed.2 Other risk factors for suicide include co-occurring substance or alcohol abuse and mental disorders; a family history of suicide; physical illness; relational, social, work, or financial loss; and easy access to lethal methods, especially guns.3 Finally, youth who have experienced stressful life events, who have poor levels of communication with their parents, and who have been exposed to the suicidal behaviors of others are more likely to commit suicide65Adreanne Waller, MPH - Washtenaw County Public HealthNational 13% of high school students yrbs -201166Adreanne Waller, MPH - Washtenaw County Public HealthNational 8% of high school students67No Data11.9% - 13.8%13.9% - 15.3%15.4% - 17.3%17.4% - 20.6%Percentage of High School Students Who Were Electronically Bullied**Including being bullied through e-mail, chat rooms, instant messaging, websites, or texting during the 12 months before the survey.State Youth Risk Behavior Surveys, 2013This slide shows the percentage of students who had ever been electronically bullied during the past 12 months, 2013. The values range from 11.9% to 20.6%. Alabama, Delaware, Florida, Kentucky, Massachusetts, Mississippi, New Mexico, North Carolina, South Carolina, Texas, range from 11.9% to 13.8%. Alaska, Georgia, Maryland, Nevada, New Jersey, New York, Ohio, Oklahoma, Rhode Island, Virginia, range from 13.9% to 15.3%. Hawaii, Illinois, Kansas, Louisiana, Nebraska, North Dakota, Tennessee, Utah, West Virginia, Wyoming, range from 15.4% to 17.3%. Arkansas, Connecticut, Idaho, Maine, Michigan, Montana, New Hampshire, South Dakota, Vermont, Wisconsin, range from 17.4% to 20.6%. Missouri, Arizona, did not ask this question. California, Colorado, Indiana, Iowa, and Pennsylvania did not have weighted data. Minnesota, Oregon and Washington did not participate.68Emergency Room Admissions for Suicide Attempts in Washtenaw County ResidentsAdreanne Waller, MPH - Washtenaw County Public Health

Hospital and ER admissions for suicide attempts will NOT tell us aboutWashtenaw County residents who were admitted to hospitals other than SJMH or UMHS for suicide attempts, i.e. VASuicide attempts that did not result in medical careCompleted suicidesSome unintentional injuriesAdreanne Waller, MPH - Washtenaw County Public Health

Total Suicide Attempt Admissions During Jan 2011 March 2014 - 1,557

That Is Approximately 5 Of Every 1000 Washtenaw County ResidentsSaint Joseph mercy hospitals &University of Michigan Health System

Washtenaw county residents onlyAdreanne Waller, MPH - Washtenaw County Public Health71

Adreanne Waller, MPH - Washtenaw County Public Health

Approximately 12 Intentional Self Harm Related ED Admissions Per Week for Washtenaw County Residents (NOT COUNTING VA)Age Distribution Intentional Injuries/Poisonings Emergency Room Admissions Washtenaw County ResidentsAdreanne Waller, MPH - Washtenaw County Public HealthApproximately 2/3 of self harm admissions were associated with poisoning by solid or liquid substance. Nearly all of these were drugs.

Adreanne Waller, MPH - Washtenaw County Public Health

Emergency Department AdmissionsWashtenaw County ResidentsUMHS and SJMH Jan 2011 March 2014 Seasonal Patterns by Drug Group Admissions for Suicide Attempts-