The Future of Public Health And Oregon’s Early Learning System May 12, 2014 PRESENTED BY Teri Thalhofer Dana Hargunani

Agenda EVIDENCE FOR EARLY HUB OVERVIEW PUBLIC HEALTH AND EARLY LEARNING COLLECTIVE IMPACT DISCUSSION

Evidence for Early  Critical aspects of brain architecture are established before and soon after birth  Experiences during sensitive periods of development play an exceptionally important role in shaping the capacities of the brain and other vital organs  Difficult for new/different experiences to alter.

Early Investments The evidence is quite clear: early health and early childhood development from birth to age 5 is a form of preventive health and economic investment that drives achievement and economic returns. Gabriella Conti and James J. Heckman Investing in What Works for America’s Communities

Early Learning Council Goals THE GOALS  Children ready for success in kindergarten when they arrive.  Children raised in stable and attached families.  Services that are integrated and aligned into one early learning system focused on results.

 45,000 children born each year  315,000 ages 0-6  40% at risk (n=~120,000)  $380+ million per year focused on prevention  $1.7 billion per biennia on young children/families  Serving 25-33% of at-risk children Oregon Snapshot

Oregon’s Kindergarten Assessment  Early Literacy (direct assessment)  Letter names  Letter sounds  Early Math (direct assessment)  Numbers and operations  Approaches to Learning (observational assessment)  Child Behavior Rating Scale

Our results  1/3 of entering kindergartners could name 5 or fewer letters  1 in 7 children couldn’t name any letters  Over 1/3 couldn’t identify a single letter sound  One quarter of entering kindergartners did not regularly demonstrate skills like completing tasks and following directions.

WHAT IS AN EARLY LEARNING HUB?  A self-organized community-based coordinating body created to provide a “system approach” to early childhood education that works to improve efficiency and outcomes for our youngest children. Early Learning Hubs

EARLY LEARNING HUB WILL  Build on existing community resources and assets  Ask tough questions about what could be done differently to get better results, especially for at risk children  Communities can define their own strategies and service areas to achieve the outcomes  Bring public schools, early learning providers, health care, social services and the private sector together around shared outcomes, for the first time in Oregon’s history.

Early Learning Hubs

Health System Kindergarten readiness Stable/attached families Early Learning System Coordinated systems Public Health Strategies Better health Lower costs Better care Kindergarten Assessment: The Look Forward and Look Back Achieving Cross-system Goals

Health Role in Early Learning  Monitoring developmental progression  Physical, language, social, emotional development  Assuring safe and nurturing environments  Identification of risk to health/development  Referral and coordination of care  Trusted information resource e.g. child care, education  Health of the family  Physical, behavioral, mental, dental

Public Health Strategies  Data: Assessment and Surveillance  Conceptual framework and research basis  Family planning: One Key Question  MCH home visiting programs  Care coordination/Case management  Health and nutrition standards in early learning programs  Connecting pregnant women and children to health coverage  Food security and nutrition: WIC program  Water fluoridation and dental care  Immunizations

Early Head Start ~1,120 served mostly fed; 68 State Healthy Families Oregon ~3,181 served (90- 95% GF; MAC, local match) Nurse Family Partnership ~623 served FFS/TCM/GF/MIECH V Babies First! ~6,000 served TCM/GF/MCH block grant Maternity Case Management 2,660 served FFS/MCH block grant Children’s Relief Nursery ~2,685 served 50/50 GF, local fund- raising Health System Education System (ODE/Early Learning/Federal) Early Intervention ~3,000 served (20% fed, 80% GF) Cacoon ~1,800 served TCM/GF/MCH block grant Family Support (DHS) OR Home Visiting System MIECHV Migrant/Season al Early Head Start ~ 698 (fed), 18 (state) served AI/AN Early Head Start ~ 72 (fed) and 2 (state) served

Collective impact  Collective Impact: the commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem.  Five Conditions of Collective Success  Common Agenda  Shared Measurement Systems  Mutually Reinforcing Activities  Continuous Communication  Backbone Support Organization  John Kania & Mark Kramer, Collective Impact, Stanford Social Innovation Review, Winter 2011

Joint Early Learning and Health Policy Chartered by the Early Learning Council and the Oregon Health Policy Board Kindergarten readiness as a common agenda Establish shared incentives Implement a shared measurement strategy Develop opportunities for cross-system learning and information exchange Adopt and implement statewide system of screening Focus on coordination of services

Collective Impact Strategies  Shared developmental screening efforts  Connecting to appropriate services; coordination of care  Implement screening in prenatal settings  Mental/behavioral/social health screening tools, connection to resources  Expand early literacy programs in community settings  Support a coordinated system of home visiting  Innovative use of TCM dollars in CCO global budget  Care coordination  Public health/CCO/Medical Home/Early Learning Hubs  Developmental origins of health and disease (DOHaD)  Role of nutrition and stress in preconception/prenatal period

State Level Data help measure progress over time Data help target resources to Early Learning Hubs and schools Early Learning Hubs Data help measure progress over time Data help target local supports, strategies and interventions Community Level Schools: Data inform classroom instruction Pre-K and Early Learning: Data inform program and system design Kindergarten Assessment: The Look Forward and Look Back

Public Health and Hubs  Work together to collectively impact shared goals  Identify the children/families that need help the most  Work with families to identify their unique and specific needs  Link families with services and providers who can best address their needs  Account for outcomes collectively and cost effectively

Questions and Discussion How does the future of public health align/integrate with early learning?

Teri Thalhofer, RN, BSN Director, North Central Public Health District Wasco-Sherman-Gilliam Counties Dana Hargunani, MD, MPH Child Health Director Oregon Health Authority Contact Information