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Findings Available
Interim Descriptive/Analytical Findings
Findings
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11/01/01:
Cuyahoga County Early Childhood Initiative: Early Childhood Initiative Evaluation and Research Interim Report
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Interim Descriptive/Analytical Findings:
Population Indicators Study:
Abuse and neglect: Child abuse and neglect rates for children under 6 were consistent throughout the ’90s. It is too early to observe any reduction in these rates as the ECI went into effect only in 1999. However, recent birth cohorts show a slightly lower chance of experiencing a second incident of maltreatment within two years, a trend that suggests, if it continues, the ECI may be having a preventative effect.
Health insurance coverage: A large improvement occurred in health insurance coverage, both privately and publicly funded, for young children between 1998 and 2001, with the estimated percent of uninsured children under age 6 falling markedly from 10.5 percent to 2.1 percent.
Poverty rate. Although 2000 Census data are not yet available, child poverty in Cuyahoga County is likely to have fallen slightly from the 1990 rate of 24 percent, consistent with national trends attributable to welfare reform and a strong economy during the period. The percentage of children under age 6 who were on cash welfare in the County fell from almost 40 percent in 1992 to 15 percent in 2000. Although most of these former welfare families have higher incomes than they did on welfare, more than half remain near the poverty line, and this economic reality is a reason the ECI is needed now more than ever.
Regulated child care. Enrollment of children under age 3 in regulated child care has nearly doubled since the inception of the ECI. About one-third of these children are subsidized by vouchers.
Preschool attendance. In 2001, 76 percent of 3 and 4 year-olds were enrolled in some type of preschool program, including Head Start, public preschool, private preschools or combined child care and preschool programs. This is much higher than the national preschool enrollment rate of 57 percent.
Death rate. The number of deaths among children under age 6 continued to fall throughout the decade.
Other significant demographic trends. The persistence of high rates of low birth weight, despite the leveling of teen and out-of-wedlock births, supports the decision of the ECI to pilot a prenatal program.
System and Policy Change Study:
Level of collaboration: New collaboration between private and public funders has led to a more unified vision for systemic change and the funding to sustain it; increased cooperation among program implementers has decreased service duplication and improved service integration and efficiency.
Policy development:: Service delivery planning has been transformed to meet specific needs and engage in problem solving around how to integrate services for young children and families. The promise of the ECI has been recognized outside the County as well, and some programmatic components are in fact serving as a model for the State of Ohio. The ECI has also become a magnet for a variety of additional projects and resources that have the potential to further its aims and vision.
Needed system changes: Increased efforts are needed to raise public awareness about the ECI and to ensure that service providers can effectively communicate information about the system to parents. Internal communication among contractors and between contractors and the ECI could be improved. Attention to transitions between programs for birth and age 3, age 3 to 5, and kindergartners is needed. Key informants express the need to secure the financial, political and structural sustainability of the ECI.
Home Visitation Studies
Service coverage: Since July 1999, Welcome Home visits have been provided to almost 14,000 new and teen parents, a number that represents more than 88 percent of all new and teen births in the County. Since July 1999, more than 13,000 families have been referred to Early Start.
Client satisfaction: More than 90 percent of Welcome Home participants responding to a County-administered consumer survey reported satisfaction with the home visiting service. Virtually all Welcome Home participants interviewed as part of the evaluation expressed high praise for the nurse visit and did not express unmet needs.
Types of families served: The evaluation sample mirrors the characteristics of the broad pool of families who are receiving both Welcome Home and Early Start visits in terms of problems presented, location of the home and source of referral. Families eligible for Early Start present a range of demographic, environmental, social and developmental risk factors that place their children at increased risk for abuse or other negative outcomes. In fact, families referred to Early Start from Welcome Home and Ohio Works First (the County welfare program) have an elevated risk for maltreatment. Neither group appears to be at the highest end of the risk continuum, however.
Service delivery: Over time, it appears families are engaging in Early Start services closer to the birth of their children and receiving a higher proportion of planned services. However, as with other intensive home visitation services that have been studied nationally, families receive only about half of the intended service dosage.
Staff satisfaction and training. Home visitors and supervisors are well educated and generally satisfied with Early Start. More than 75 percent of staff were satisfied with their agency’s management of Welcome Home and Early Start. A sizable proportion of home visitors (and supervisors) reported no prior experience in delivering home visitation services. This finding suggests that expanded training and support may be necessary to insure that the model is implemented as designed.
Family Child Care Homes Study:
Service coverage: Since July 1999, 1,433 new family child care homes have been trained and certified, representing nearly a 150 percent increase in the number of certified child care homes in the County. (The number of certified homes as of June 30, 1999 was 963.) Approximately nine percent of these new providers have withdrawn from the service network, a much lower rate of attrition than that found in other studies of family child care (30-40%).
Training provided: Of the homes that have been certified to date, 84 percent have received post-certification technical assistance and 56 percent have received visits related to quality enhancement.
Turnover rates: Of the 1,433 new homes certified under the ECI, 127 or 9 percent have left the program. This rate of turnover is one-half to one-third of that noted in other published studies of family child care providers.
Quality improvement: Quality improvement cannot be judged yet, since only baseline ratings have been made. Prior to receiving technical assistance (i.e., baseline), the new family child care homes fell into the poor range on the Family Day Care Rating Scale, suggesting that the ECI is potentially addressing an existing need for quality improvement.
Special Needs Child Care Study:
Increased capacity: An estimated 68 child care programs served children with special needs in the County before the ECI began; now there are an estimated 170 such programs. In addition, between December 2000 and June 2001, the number of family child care homes providing care for a child with special needs increased from 27 to 36 homes. Additionally, the number of providers who expressed willingness to serve children with special needs increased from 256 to 339.
Training provided: In total, 429 individual child care providers made 717 requests for training on special needs, which were handled during the period of January 2000 to March 2001. There is no clear pattern over the five quarters examined, however, that providers are attending training sessions on a range of subjects related to special needs child care. Of the children on whose behalf technical assistance was delivered, seven visits were delivered on average per child and 21 visits per child care program.
Stabilization of care: The available data provides limited information about whether the ECI training program has stabilized care for the special needs children on behalf of whom it has been provided, although focus group attendees agreed that technical assistance can be an essential tool in helping them accommodate special needs children.
Client satisfaction: Providers and parents report that the technical assistance provided by community-based agencies made a substantial difference in the quality of care provided to special needs children. In addition, the views of focus group participants suggest that there are now an adequate number of child care spaces available for these children.
Unmet needs: Data from focus groups suggest the need for (1) enhancements in public welfare caseworkers’ knowledge about children with special needs; (2) increases in the level of child care reimbursement for children with special needs; (3) a centralized source of information for families related to children with special needs; and (4) a mechanism for linking parents with providers who offer high-quality child care for children with special needs.
Healthy Start/Medicaid Expansion Study:
Indicators of expanded coverage: The 1998 Ohio Family Health Survey found that 12.5 percent of children 18 years and under and 10.5 percent of those age 5 and under in Cuyahoga County lacked health insurance. A follow-up survey in 2001 found that the number of uninsured children 18 years and under in the County had declined to 7.4 percent. Only 2.1 percent of children age 5 and under were uninsured by 2001.
Medicaid enrollment and outreach: almost uninterrupted increase in the enrollment of younger children since December 1999, with a dramatic increase beginning in September 2000. Enrollment for older children has increased substantially since September 2000, as well. Recent data from Cuyahoga Health & Nutrition (County department) show an increase in the average monthly call volume on the Healthy Start hotline since January 2000, as well as an increase in the average number of Medicaid applications received per month from all sources.
Stability of coverage: Preliminary analysis found that Medicaid enrollment began earlier and spells of uninterrupted eligibility increased in duration for children born after mid-1999 as compared to children born prior to mid-1999. This suggests a trend toward more stable coverage for young children.
Population Indicators Study:
Abuse and neglect: Child abuse and neglect rates for children under 6 were consistent throughout the ’90s. It is too early to observe any reduction in these rates as the ECI went into effect only in 1999. However, recent birth cohorts show a slightly lower chance of experiencing a second incident of maltreatment within two years, a trend that suggests, if it continues, the ECI may be having a preventative effect.
Health insurance coverage: A large improvement occurred in health insurance coverage, both privately and publicly funded, for young children between 1998 and 2001, with the estimated percent of uninsured children under age 6 falling markedly from 10.5 percent to 2.1 percent.
Poverty rate. Although 2000 Census data are not yet available, child poverty in Cuyahoga County is likely to have fallen slightly from the 1990 rate of 24 percent, consistent with national trends attributable to welfare reform and a strong economy during the period. The percentage of children under age 6 who were on cash welfare in the County fell from almost 40 percent in 1992 to 15 percent in 2000. Although most of these former welfare families have higher incomes than they did on welfare, more than half remain near the poverty line, and this economic reality is a reason the ECI is needed now more than ever.
Regulated child care. Enrollment of children under age 3 in regulated child care has nearly doubled since the inception of the ECI. About one-third of these children are subsidized by vouchers.
Preschool attendance. In 2001, 76 percent of 3 and 4 year-olds were enrolled in some type of preschool program, including Head Start, public preschool, private preschools or combined child care and preschool programs. This is much higher than the national preschool enrollment rate of 57 percent.
Death rate. The number of deaths among children under age 6 continued to fall throughout the decade.
Other significant demographic trends. The persistence of high rates of low birth weight, despite the leveling of teen and out-of-wedlock births, supports the decision of the ECI to pilot a prenatal program.
System and Policy Change Study:
Level of collaboration: New collaboration between private and public funders has led to a more unified vision for systemic change and the funding to sustain it; increased cooperation among program implementers has decreased service duplication and improved service integration and efficiency.
Policy development:: Service delivery planning has been transformed to meet specific needs and engage in problem solving around how to integrate services for young children and families. The promise of the ECI has been recognized outside the County as well, and some programmatic components are in fact serving as a model for the State of Ohio. The ECI has also become a magnet for a variety of additional projects and resources that have the potential to further its aims and vision.
Needed system changes: Increased efforts are needed to raise public awareness about the ECI and to ensure that service providers can effectively communicate information about the system to parents. Internal communication among contractors and between contractors and the ECI could be improved. Attention to transitions between programs for birth and age 3, age 3 to 5, and kindergartners is needed. Key informants express the need to secure the financial, political and structural sustainability of the ECI.
Home Visitation Studies
Service coverage: Since July 1999, Welcome Home visits have been provided to almost 14,000 new and teen parents, a number that represents more than 88 percent of all new and teen births in the County. Since July 1999, more than 13,000 families have been referred to Early Start.
Client satisfaction: More than 90 percent of Welcome Home participants responding to a County-administered consumer survey reported satisfaction with the home visiting service. Virtually all Welcome Home participants interviewed as part of the evaluation expressed high praise for the nurse visit and did not express unmet needs.
Types of families served: The evaluation sample mirrors the characteristics of the broad pool of families who are receiving both Welcome Home and Early Start visits in terms of problems presented, location of the home and source of referral. Families eligible for Early Start present a range of demographic, environmental, social and developmental risk factors that place their children at increased risk for abuse or other negative outcomes. In fact, families referred to Early Start from Welcome Home and Ohio Works First (the County welfare program) have an elevated risk for maltreatment. Neither group appears to be at the highest end of the risk continuum, however.
Service delivery: Over time, it appears families are engaging in Early Start services closer to the birth of their children and receiving a higher proportion of planned services. However, as with other intensive home visitation services that have been studied nationally, families receive only about half of the intended service dosage.
Staff satisfaction and training. Home visitors and supervisors are well educated and generally satisfied with Early Start. More than 75 percent of staff were satisfied with their agency’s management of Welcome Home and Early Start. A sizable proportion of home visitors (and supervisors) reported no prior experience in delivering home visitation services. This finding suggests that expanded training and support may be necessary to insure that the model is implemented as designed.
Family Child Care Homes Study:
Service coverage: Since July 1999, 1,433 new family child care homes have been trained and certified, representing nearly a 150 percent increase in the number of certified child care homes in the County. (The number of certified homes as of June 30, 1999 was 963.) Approximately nine percent of these new providers have withdrawn from the service network, a much lower rate of attrition than that found in other studies of family child care (30-40%).
Training provided: Of the homes that have been certified to date, 84 percent have received post-certification technical assistance and 56 percent have received visits related to quality enhancement.
Turnover rates: Of the 1,433 new homes certified under the ECI, 127 or 9 percent have left the program. This rate of turnover is one-half to one-third of that noted in other published studies of family child care providers.
Quality improvement: Quality improvement cannot be judged yet, since only baseline ratings have been made. Prior to receiving technical assistance (i.e., baseline), the new family child care homes fell into the poor range on the Family Day Care Rating Scale, suggesting that the ECI is potentially addressing an existing need for quality improvement.
Special Needs Child Care Study:
Increased capacity: An estimated 68 child care programs served children with special needs in the County before the ECI began; now there are an estimated 170 such programs. In addition, between December 2000 and June 2001, the number of family child care homes providing care for a child with special needs increased from 27 to 36 homes. Additionally, the number of providers who expressed willingness to serve children with special needs increased from 256 to 339.
Training provided: In total, 429 individual child care providers made 717 requests for training on special needs, which were handled during the period of January 2000 to March 2001. There is no clear pattern over the five quarters examined, however, that providers are attending training sessions on a range of subjects related to special needs child care. Of the children on whose behalf technical assistance was delivered, seven visits were delivered on average per child and 21 visits per child care program.
Stabilization of care: The available data provides limited information about whether the ECI training program has stabilized care for the special needs children on behalf of whom it has been provided, although focus group attendees agreed that technical assistance can be an essential tool in helping them accommodate special needs children.
Client satisfaction: Providers and parents report that the technical assistance provided by community-based agencies made a substantial difference in the quality of care provided to special needs children. In addition, the views of focus group participants suggest that there are now an adequate number of child care spaces available for these children.
Unmet needs: Data from focus groups suggest the need for (1) enhancements in public welfare caseworkers’ knowledge about children with special needs; (2) increases in the level of child care reimbursement for children with special needs; (3) a centralized source of information for families related to children with special needs; and (4) a mechanism for linking parents with providers who offer high-quality child care for children with special needs.
Healthy Start/Medicaid Expansion Study:
Indicators of expanded coverage: The 1998 Ohio Family Health Survey found that 12.5 percent of children 18 years and under and 10.5 percent of those age 5 and under in Cuyahoga County lacked health insurance. A follow-up survey in 2001 found that the number of uninsured children 18 years and under in the County had declined to 7.4 percent. Only 2.1 percent of children age 5 and under were uninsured by 2001.
Medicaid enrollment and outreach: almost uninterrupted increase in the enrollment of younger children since December 1999, with a dramatic increase beginning in September 2000. Enrollment for older children has increased substantially since September 2000, as well. Recent data from Cuyahoga Health & Nutrition (County department) show an increase in the average monthly call volume on the Healthy Start hotline since January 2000, as well as an increase in the average number of Medicaid applications received per month from all sources.
Stability of coverage: Preliminary analysis found that Medicaid enrollment began earlier and spells of uninterrupted eligibility increased in duration for children born after mid-1999 as compared to children born prior to mid-1999. This suggests a trend toward more stable coverage for young children.
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02/01/03:
Cuyahoga County Early Childhood Initiative Evaluation: Phase I Final Report, Entire Report
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Final Descriptive/Analytical Findings:
Capacity and Systems Findings:
- In 2.5 years of operation, the ECI reached nearly 83,000 Cuyahoga County children
(prenatal through five years of age), and approximately 68% of children born since the start of ECI have received one or more ECI services. Since the start of ECI, Welcome Home visits have been made to over 19,700 new and teen parents, representing 86 percent of all those eligible for the service.
- Since the launch of ECI, 15,441 children, 69% under six months of age, have been
referred for Early Start services.
- The Family Child Care Homes program led to the certification of 1,499 new home-based child care providers, a 150% increase since the start of the Initiative, and 74% of these providers received technical support visits.
- The Special Needs Child Care program has delivered technical assistance on behalf or nearly 1,200 children with special needs [based on data from families that consented to participate in the evaluation], trained over 900 providers, and helped more than 250 families through placement assistance.
- From the perspective of a sample of key informants, the Initiative has facilitated a cultural shift among the organizations involved to create a coordinated response to children's needs, established formal, structured collaborations that did not previously exist, facilitated cross-system referrals, and developed new linkages between communitybased agencies and families across the County.
- From the perspective of a sample of key informants, however, some barriers remain, including concerns about long-term political support, long-term funding, and the availability of a sufficient and qualified labor pool.
Outcome Findings:
- Enrollment of children under age 3 in regulated child care increased by 25% since the inception of the ECI, and 76% of 3- and 4- year-olds were enrolled in some type of preschool in 2001, compared to 57% nationally.
- Welcome Home visits provided participants useful information in identifying health and related resources for their children and in offering guidance in basic child care strategies.
- A greater number of Early Start services had modest predictive ability in explaining a participant’s reduced risk for physical abuse and increased sense of competence and comfort in caring for her child.
- Over the three years, family child care provider income increased 58%, on average, and the mean number of children in care increased by 53% (from 3.0 to 4.6 children).
- The receipt of TA and training related to caring for children with special needs was found to be associated with a greater willingness to care for children with special needs.
- Eighty percent of children with special needs whose caregivers received TA remained in their child care placement for six months or more.
- The percent of medically uninsured children under age 6 in Cuyahoga County decreased from 10 percent to 2 percent between 1998 and 2001 (latest data available).
- The proportion of infants enrolled in Medicaid who received a well-baby visit within the first month of life increased from 30% to 43% between 1998 and 2001, and the proportion receiving the intended five visits during the first year of life nearly doubled (from 11% to 21%).
Final Implementation/Process Findings:
Service Provision and Quality Findings:
- Infants are being served earlier in life as the Initiative progresses, with 63% of infants
being served by three months of age in the most recent birth cohorts.
- More children born in 2000 were identified as needing Early Intervention services and were identified at an earlier age than prior to the Initiative.
- Similarly, Early Start home visits are being delivered much earlier in infants’ lives, such that infants referred for service before their 6- month birthday receive an initial home visit within the first month of life.
- Early Start referrals with the highest level of risk are twice as likely to receive an initial home visit and engage in the program as those referrals with fewer presenting problems.
- On average, over a 9-month period Early Start families received 11.3 visits,
approximately half the number of intended home visits, comparable to service levels
achieved in similar early intervention programs.
- Improving the quality of care in family child care homes proved difficult. Over a 12-month period, the overall quality of care remained poor in a sample of family child care homes. However, the retention of quality was found to be correlated with factors that could be influenced by policymakers: a greater number of technical assistance visits, seeking providers with limited child caregiving experience pre-certification, and fewer children in care.
- During ECI, the percentage of children enrolling in Medicaid during the first month of life increased from 45% to 62%, and the percentage disenrolling within 13 months after initial enrollment decreased from 36% to 25%.
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10/01/04:
Cuyahoga County Early Childhood Initiative: Welcome Home and Early Start
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Interim Implementation Findings:
- Three months after receiving their visit, Welcome Home participants report remembering and using the infant care information given to them by the nurse.
- Newborns and their parents are being provided ongoing home visitation services much
earlier in the infant’s life than had been true in 1999.
- On average, all new parents, regardless of personal and economic resources, appear to
experience a significant loss in their sense of emotional connection and belonging to
those in their informal support network and an increase in perceived stress, underscoring
the importance of universal support.
- Early Start referrals who present the highest level of risk, as measured by the Child
Abuse Potential Inventory (CAP), are twice as likely to receive an initial home visit and
engage in the program as those with the lowest CAP scores. However, about one-third of all referrals never receive a home visit.
- The average Early Start participant who received a minimum of 15 visits demonstrated
significant improvement in her level of depression, perception of stress, and sense of
competence and comfort in caring for her child.
- Retention in Early Start, and consequently more home visits, is far more likely if the
participant and home visitor are able to establish a strong relationship based on a mutual
understanding of the purpose of Early Start and a mutual respect for what each can bring
to the service relationship.
- Enrollment and retention rates varied across Early Start service providers.
- Significant and persistent differences in Early Start service duration and dosage existed
between African American and non-African American participants.
- In the first 6 months following enrollment in the study, approximately 6 percent of the
total sample and 8 percent of those referred to Early Start were reported for suspected
child abuse and neglect.
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05/01/05:
Cuyahoga County Early Childhood Initiative: Phase II Final Report Executive Summary
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Final Descriptive/Analytical Findings:
- A community-wide network of services for young children and their families has been
established, and the apparatus of county government has been altered to directly support
and coordinate early childhood services.
- More children under age six in Cuyahoga County are receiving needed services at earlier ages than ever before.
- Children and their parents are beginning to show benefits from the services provided through the initiative.
- Efforts to deepen and extend the services, tailor them to individual needs, and assure
continuing quality should continue.
- The public and private partners who established this Initiative have maintained their
commitment for half a decade and recently recommitted to it, with a new strategic plan
that outlines a continued focus on program improvement based on evaluation.
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