FIRST 5 Santa Clara County: Prevention Opportunities and a Systems Approach Early Childhood Funders Meeting Thursday, May 23, 2013

FIRST 5 Who We Are Our Vision To act as a catalyst for ensuring that the developmental needs of children through age 5 are a priority in all sectors of the community. Our Mission To support the healthy development of children through age 5 and enrich the lives of their families and communities.

Circles of Influence Ecological Systems Model adapted from: Bronfenbrenner, U. (1989)

Neighborhood Support Early Care and Education Family Support Health Care GOAL 1 Children are born healthy and experience optimal health and development GOAL 2 Families provide safe, stable, loving and stimulating homes GOAL 4 Neighborhoods and community are places where children are safe, neighbors are connected and all cultures are respected GOAL 3 Children enter school fully prepared to succeed academically, emotionally, and socially GOAL 5 Systems are responsive to the needs of children and families FIRST 5 Goal Areas

FIRST 5 County-Wide Service Delivery Continuum Children 0-5 Children in system entry points and at 300% of Federal Poverty Level Children 0-5 and their families Children and families who are screened and in need of one-on-one parenting skills intervention Children and families that require intensive intervention services Workforce Development & Family Support Strengthening Research and Evaluation Continuous Improvement SCC Community Communication, Education & Information Community Outreach, Learning Together Initiative, Physical Health Quality early learning environments, PoP, Educare Mental Health Department Call Center and Regional Assessment Centers Community-based HV, Medi-Cal providers Community-based therapeutic services, Medi-Cal providers Community Engagement and Education Support Home Visitation Early Care and Education Assessment Communication, Education, & Information Therapeutic Services

Where FIRST 5 Serves – Countywide Risk Factors Children living in high/ multiple risk environments are at greater risk of: - Physical impairment - Cognitive impairments - Social, emotional, and behavioral impairments - Poor developmental outcomes - Serious emotional problems Children living in high/ multiple risk environments are at greater risk of: - Physical impairment - Cognitive impairments - Social, emotional, and behavioral impairments - Poor developmental outcomes - Serious emotional problems 6

Developmental Screening Initiative Evolution

Developmental Screening Target Population Most vulnerable children birth through 5 in Santa Clara County Superior Court System (Family, Dependency & Probation) SCCOE: Head Start SCCOE: Early Start San Andreas Regional Center FIRST 5 Early Learning Programs Preschool / Early Learning Programs VMC Pediatric Offices / Community Health Clinics Santa Clara County Mental Health Department Public Health Nursing WIC Community Based Organizations FIRST 5-Funded Community Operated Family Resource Centers 8

Referral Pathway & MHD Call Center 9 Developmental Screening Target Population KidConnections Network of Providers

Santa Clara County STARTS System Screening to Assessment, Referral, and Treatment Mental Health Department Call Center Phone: Fax: Mental Health Department Call Center Phone: Fax: KidConnections Network of Providers (Screening, Assessment, Home Visitation, Therapeutic Services) KidConnections Network of Providers (Screening, Assessment, Home Visitation, Therapeutic Services) ASQ/ASQ-SE Screenings and Concerns Referrals Intervention Services

Partnership: FIRST 5 and Mental Health Department (MHD) Since 2006, FIRST 5 and MHD have partnered to provide screening and early intervention services to children in Santa Clara County. Shared Vision of Universal Screening and Intervention Braided and Leveraged Funding for Sustainability & Capacity Building Programmatic Service Efficiencies Implementation of Evidence-Based Practices Shared Resources for Workforce Development Research-Based Screening and Assessment Tools Rigorous Evaluation Plan Commitment to Continuous Improvement 11

FIRST 5 Leverages $2.54 for every $1 of Investment 12

KidConnections Network (KCN) of Providers In collaboration with FIRST 5 Santa Clara County, Santa Clara County Mental Health Department and Community Based Organizations - KCN provides high quality, transdisciplinary screening, assessment, home visitation and therapeutic services for children under 6 years of age Partnering with the community: – Pediatric Workgroup – Provider Workgroup – FIRST 5, MHD, CBO - Executive Director Workgroup 13

14 KidConnections Network of Providers: Coordination of Services Developmental Services Community Solutions Rebekah’s Children’s Services Gardner Family Care Alum Rock Counseling Center EMQ Families First MHD KidScope Kidango Catholic Charities Regional Assessment Centers Mental Health Services Feedback Loop Feedback Connection to Early Start & School District Services Children’s Health Council Provider Self-Referral

What we’ve learned so far… Selected Outcomes FY 12-13

Ensuring Children Thrive It is projected that at the end of FY 12-13, 2250 children aged 0-5 will have received services under Santa Clara County’s KCN Network of Providers. This is an increase of 29% from the previous year. Desired Outcomes: 1) children are born and remain healthy. 2) Families have the skills, support & resources they need to promote their children’s optimal development, and 3) children have age-appropriate competencies (social, emotional and cognitive)

ASQ-3 and ASQ:SE Presenting Concerns

Our children have high levels of need Presenting concerns: CBCL Symptom Cluster –Note, symptom clusters do not directly correlate to diagnosis % in Clinical Range at Initial Assessment-System Clusters Attention30% Anxiety32% Anger/Aggression36% Affective (Mood)38% Social / Communication/ Symbolic Thinking54% N = 388 completed initial assessments using the Child Behavior Checklist

Parent-Child Relationships Improved

Promoting Learning

Supporting Child’s Confidence: Improved

Where We Are Going… Systems Working Together to Support Developmental Screening 22

Universal Developmental Screening: Santa Clara County Leading the Way 23 Source:

FIRST 5 Santa Clara County Partnership with the Superior Court and Child Welfare Systems

25 Partnerships FIRST 5 has strong, collaborative relationships with county agencies and departments and community partners, allowing for the expansion and strengthening of our countywide System of Care, maximization of revenue and assurance that programs are sustainable over time.

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27 Superior Court and Child Welfare Systems Family CourtJuvenile JusticeDependency Making Connections – Family Support Specialists & Public Health Nurses Family Support Specialists & Public Health Nurses Family Support Specialists Public Health Nurses AssessmentTherapeutic ServicesHome Visitation Early Care & Education Family Resource Centers Early Start/ School District

28 Santa Clara County Superior Court: Family Court Family Court Family Support Specialists provide: Developmental Screenings, Needs Assessments and connect families to FIRST 5 and community programs. Staff is stationed in each of the county Family Court Houses to connect directly on-site with families and to receive referrals.

29 Santa Clara County Superior Court: Juvenile Justice Court Juvenile Justice Court Family Support Specialists provide: Developmental Screenings, Needs Assessments and connect pregnant and parenting teens to FIRST 5 system of care. Referrals are made directly from Judges and Probation Officers.

30 Santa Clara County Superior Court: Juvenile Dependency Family Support Specialist sits as a member of the Dependency Wellness Court team to provide information and resources regarding community resources and child development. Public Health Nurses provide Nursing Assessments, Depression Screening, ASQ and ASQ:SE screenings to all children involved in the child welfare system Families are connected to other FIRST 5 and community programs.

31 NCFAS Assessment of Family Court Participants 31 Overall environment is not shown, as there was no measureable change in % after 90 days All improvements are statistically significant at p <

32 Public Health Nursing – Home Visitation Highlights Children in dependency court were more likely to receive the recommended number of well-child visits and less likely to visit the ER room at follow-up

33 Public Health Nursing – Home Visitation Highlights Children in dependency court were more likely to receive adequate dental care at follow- up

34 Public Health Nursing - ASQ and ASQ-SE Highlights Children in dependency court matched at baseline and follow-up presented with significantly fewer concerns in all domains at follow-up Decreased % indicates improvement

35 FIRST 5 Santa Clara County: State and Local Recognition Superior Court of California County of Santa Clara Support for Family and Juvenile Courts Award 2012 Legal Advocates for Children and Youth Innovative Program Award 2011 Judicial Council of California Ralph N. Kleps Award for Improvement in the Administration of the Courts 2009 Association of Family and Conciliation Courts Irwin Cantor Award for Innovative Programs 2008

Questions and Answers

For More Information 37 Melanie Daraio Rachel Talamantez FIRST 5 Santa Clara County 4000 Moorpark Ave., Suite 200 San Jose, CA Phone: (408)