A Report to the Community:
Invest in Children’s Impact to Date
Rob Fischer, Ph.D.
Claudia Coulton, Ph.D.
Overview
• Building an initiative and creating a system for
meeting the needs of young children
• Highlights of IIC programming results to date
• Creating an integrated child data system as a
community resource to inform policy and
practice
The Trajectory of the System
2012
2004
1999
Public/Private
Partnership
created
Office of Early
Childhood/
Invest in
Children
created
Datainformed
system in
place
Early Childhood System
Invest in Children Logic Model
Strategies
Programs
Outputs
Intermediate
Outcomes
Longer-term
Outcomes
Home visiting
Effective
Parents and Families
Early Literacy and Learning
Prenatal to three system
Early Childhood Mental Health
Safe & Healthy
Children
Access & utilization of
Preventative health care
Healthy Start Outreach
Medical Home
Primary Lead Prevention
Family Child Care Homes
Regional System
Children Prepared
For School
Early Care and Education
System
Professional development
For Centers
T.E.A.C.H.
Children reached
early and
with continuity
Families
effectively
access range of
available
services
UPK
Special Needs Child Care
Community
Committed to
Children
Number of
children and
families reached
Communications campaign
Community mobilization
Disseminate findings
Caregivers
effectively
engaged
Parent and
caregivers have
increased
knowledge
and skills
Children receive
appropriate
care at home and
in other settings
Children
develop
appropriately
Positive
movement on
community-level
child well-being
indicators
Community
ethic
around our
youngest
children
Early Stages of the Initiative
• Effective Parenting
– Welcome Home (Newborn Home Visit)
• Significant gains in parent knowledge of community
resources and knowledge relating to their baby’s
health/wellness; 39% of visits led to identification of at
least one medical concern for the newborn or mother
– Early Start (Ongoing Home Visiting)
• Increased sense of parental competence and comfort in
caring for child and reduced risk for physical abuse
• High rates of immunization and access to regular doctor
Early Stages of the Initiative
• Healthy Children
– Healthy Start/Medicaid Expansion
• the percentage of children enrolling in Medicaid during
the first month of life increased from 45% to 62%;
insured children under age 6 in Cuyahoga County
increased from 90% to 98%
Early Stages of the Initiative
• Quality Child Care
– Family Child Care System
• Increasing quality among home based providers and
growing number of Gold Seal homes
• Impact greater with more intensive services
– Special Needs Child Care
• 93% of children at risk of expulsion remaining in their
child care placement for six months or more
• Based on feedback parents now receive summary of
focus of services
Expanding the Initiative
• Early Childhood Mental Health (added 2006)
– significant decline in child behavior problems and
significant improvement in parent-child relationships; 65%
of treatment goals were met by families at program exit
• Primary Lead Prevention Pilot (2006-2010)
– decreased lead dust in the home, increased knowledge of
preventing elevated blood lead levels in target infants, and
reduced blood lead levels in children in the home
• Universal Pre-K Pilot (began 2007)
– significant gains in UPK site quality and average level of
school readiness significantly exceeds the average
readiness of all children entering CMSD
Scope of IIC Services
-over 120,000 children served
Type of Service
All service types combined
Total
Served
2011
Total
Served
through
2011
13,254
120,773
Family Child Care
1,621
14,846
Ongoing Home Visiting
2,520
41,980
351
1,174
Special Needs Child Care
1,228
5,582
Early Intervention
3,497
24,273
Universal Pre-K
1,389
4,456
Newborn Home Visit
1,708
65,783
Early Childhood Mental Health
Data Informing the System
• Program development
– Medical Home pilot
– Primary Lead Prevention pilot
• Program refinement
– Home visiting
– Family child care quality enhancement
• Program targeting
– Health insurance outreach
– Newborn home visiting
The Power of Data –
Child Health Example
• Dramatic increase in health insurance coverage for
children ages 0-6: Hooray!
• But wait, only 43% of children get all the
recommended well-child visits in the first year of life:
Oh no, 
• But wait, data showed that 49% of these families were
involved with IIC services close to birth, so we can use
that connection to reach families: Hooray!
• But wait, due to data lags and coordination issues,
outreach would happen too late to have an effect: Oh,
no, 
• But wait, we could use a preventive approach by
having dedicated staff at clinics reach out to families…
The Power of Data –
Child Health Example
• Result - 2007 Medical Home Pilot with one
Patient Advocate each at NEON &
Neighborhood Family Practice
– 86% of families completed scheduled well-child
visits, double the rate for children born on to
Medicaid in Cuyahoga County
Now NFP has integrated the model
into care with 9 Patient Advocates
Now serving the needs of families
with infants
The Power of Integrated Data
The ChildHood Integrated
Longitudinal Data
(CHILD) System
A Community Resource
Created with Private Funding
Co-founders: Invest In Children & MSASS, CWRU
The Power of Integrated Data
• Data helps inform our understanding of the early
childhood system
• Individuals and families interact with multiple
systems and services, so integrated data offers a
more complete view of reality [“Big Data”]
• Understanding of how systems work and how to
better meet existing needs can be informed by
integrated data
• Service models emphasize long term and
collective impact, so data needed across services
and over time
Multiple Service Use
IIC - Origination of CHILD System
• Began with child registry of all children born in
Cuyahoga County since 1992
• Draws on routinely available administrative data
to monitor program delivery and outcomes
• Brings together data at the child level for
longitudinal analyses
• Now expanding data to reflect experiences
throughout childhood
16
CHILD System Data Sources
- 400,000 children and counting
• Birth certificates
• Maternal health
• Low birth weight births
• Death certificates
• Infant mortality
• Child welfare
• Abuse/neglect
investigations
• Placements and services
• Public school data
•
•
•
•
Attendance
Kindergarten readiness
Proficiency tests
Graduation
• Homeless Services
• Public Assistance Receipt
•
•
•
•
Medicaid receipt
Food Stamp receipt
TANF receipt
Child care voucher receipt
• IIC program participation
•
•
•
•
Home visiting services
Special needs child care
Early mental health
Universal pre-k
• Juvenile Justice
• Delinquency Filings
• Geo-data
• Neighborhood and
environmental conditions
Components of CHILD System
Program Planning
• Federal funding application for housing for
children in high risk families
Geographic analyses
Geographic analyses
Answering community
questions
• What does the CMSD kindergarten class look like?
Child & Family Well Being Indicators
% Teen Births, mother’s age 10 – 14
% Teen Births, mother’s age 15 – 19
% of Mothers without H.S. diploma
% Low Birth Weight
% Premature Low Weight Births
% Mothers w/ adequate prenatal care (Kessner Index)
% Mothers w/out prenatal care
% Healthy Births (based on information about Apgar, prenatal
care, birthweight, gestational age)
% Children with a substantiated or indicated report of
abuse/neglect by age 4
% Children referred to ongoing services with Child & Family
Services by age 4
% Children with any report of abuse/neglect by age 4, including
substantiated and unsubstantiated
% Children in households receiving Food Stamps in 2008
% Children in households receiving Cash Assistance in 2008
CMSD
Kindergarten Class
2008-091
Cleveland2
Cuyahoga
County3
<1
22.4
41.7
12.6
8.7
63.1
1.9
<1
16.7
30.2
11.6
8.2
69.4
1.7
<1
9.8
15.9
9.4
6.7
81.3
0.9
56.4
61.5
70.9
12.1
9.6
5.1
19.8
14.7
7.6
35.2
26.7
14.7
76.9
19.0
51.1
11.3
28.8
6.1
Summary
• IIC is a leading example of comprehensive
community commitment to young children with
demonstrated impact
• IIC is ahead of the curve in effort to
understanding the importance of place and the
commitment to child development over time
• CHILD system is a community resource available
to support policy, research, and practice
What's Next?
• Extend CHILD System to include data from
later adolescence (e.g., Juvenile Count
involvement, Proficiency test data)
• Undertake study to examine factors that
predict 3rd Grade Reading Proficiency
(Reading Guarantee)
• Explore mechanisms to make aggregate data
from CHILD more available to the community