AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
RALPH SCHUBERT: Okay. There we go. I want to talk a bit about a community level effort that we're undertaking for early childhood system development in contrast with what Sally talked about at the state level. And I was thinking especially when she was describing the state of MCH in Vermont, that I would love to have 90% of our women getting prenatal care in their first trimester and infant mortality rate of 5 only takes a 40% reduction from where Illinois is now. So that felt ‑‑ I was just ‑‑ one of our counties that I'm going to talk about has 2,000 more births a year than the whole state of Vermont so...
If it wasn't for the scenery I'd have a hard time ‑‑ well, anyway. All right. Let's see. Do I want to go back to that one? All right. I didn't know the animation effects were in there. This was put together by one of my staff. I have no idea what other surprises might be coming in the next few minutes. Our AOK networks, all our kids not to be confused with the health insurance program you heard about this morning at lunch, our community partnership. We're doing SECCS really at the community level and we started doing this, I don't know, five or six years ago and it really ‑‑ it came out of ‑‑ it came out of the desire to sort of link our MCH systems at the community level with our Part C system and improve the relationship between the programs that we're doing primary care and finding women and families with young kids and making sure that those kids need, who needed to be in Part C got into Part C.
Also at the time we were doing this we were in the middle of being sued for not having enough kids in Part C. So that was kind of the motivation. We need to do more linking at the community level to make sure that the kids who need to get into these higher end services actually got there. We finally succeeded, and the suit was dismissed. It was, you know, I've watched this happen three or four times over the course of my tenure in human services in Illinois and there really is some advantage in getting sued by the ACLU. It's not something I'd recommend as, you know, as a public administration strategy, but there are some advantages.
So what do we want the AOK networks to do? Improve access, increase the capacity of the system, enhance coordination and collaboration meaning especially for, especially for families that need services for more than one system. Make sure that there is a case coordination mechanism in the community, of course, we've been building silos for so long that we need to coordinate the coordinators. And that's really what that doc point is about. To make sure that there's somebody ‑‑ that there's a mechanism in the community why all of those people sit down and talk with some kind of regularity.
As a long‑term outcome, increase family satisfaction with their experience in getting services through this system. Every so often pay attention to the consumer. They do pay those taxes. And we want to engage a broad range of stakeholders in this, and I think I have a list in here about who at the local level we try to engage in building these networks.
We went through 14 drafts of logic model before the staff person with whom I work on this project and I said: Enough! So I went back to this theoretical framework that I came across in graduate school called general systems theory. And it originates ‑‑ it was developed by a professor named Ludwig Von Bertlanfee , and his interest was in chemistry and biology. So by the time I got to graduate school enough people had thought about it long enough it differentiated into other areas of endeavor or I never would have come across it.
So we look, the circle in the middle is meant to represent the service delivery system. And we look on the left side, providers and families as the main inputs going into the service delivery system. Now, the other one that really is important and is not on the diagram is money. And there are barriers that stand in the way of families entrance into services. And as a result of the delivery of services, we have where it said service delivery it's really service delivery data. We have information about what happened in the delivery of services.
Over a somewhat longer term that delivery of services does something to health status. And at the same time that services are being delivered, families have some experience of satisfaction or not. And that affecting those three things that result from the delivery of services is eventually what produces kids who are healthy and ready to learn.
So what we were able to do ‑‑ we're talking by the way some of the measures we're developing, but by moving to this sort of systems model, we got out of the linear box and arrow soup that we were getting lost in and tried to describe this as a eventually a system that feeds back on itself. But the simpler version of this is you look at the resources that you have to have in order to get services delivered. Look at the things that are getting in the way, and by way of some evidence, look at what is or may not be going well in the delivery of services and whether or not families are happy with the product that they're getting.
The AOK networks are led by a local healthy department. We did that in every case because local health departments are unique or as agencies of local government, and like Title V agencies, are responsible for the health of all women and children, as well as you know all adults and children in their community. So nobody else has or might be silly enough to undertake that level of responsibility.
So we start with local health departments. We provide the money that pays for the coordinator, and provides money for the incidental expenses that range from convening meetings to mailing things out. And their initial charge is to organize the group of stakeholders. And I was glad to see Sally put the list of essential public health services into her presentation. I was going to do the same thing, because that was the theoretical framework by which or from which we designed the AOK networks.
And I think it's a essential public health number five is mobilize community partnerships. And that's exactly where we had these health departments begin. Get everybody in the community together and you know like us at the state level involved in MCH, this is part of breathing in and breathing out for them.
So their charge is to carry out the ten essential public health services with regard to families with young children. Here are some of the kinds of folks that we brought onto the local partnerships. Obviously do healthcare, early care and education. Family support. Social Service providers. The faith community. Other parts of local government. Mental health. Families. Park districts. Libraries. Soup to nuts, anybody that you can think of, get onto the local network. The next thing we had them do was to conduct an assessment of the community, and we gave them some tools to do that. We put together a data book. This is not at all unlike the process that we go through at the state level of secondary data. Everything that we could get our hands on we organized into a binder and said, here, study this, and then gave them some very basic instruction in how to do focus groups, how to do surveys, how do you know surveys that mean something. And help them through the process of gathering primary data. They take all of that information, feed it back to their network and say, okay, guys, help us make sense, what are the priorities, where are the problems, what are the data telling us collectively?
And we used as our resource the Focus on Children manual, which was, which is a project that was really led by Colleen Monahan who is, you've heard Peter van Dyck talk about MCHCOM.com. That's sort of our broadcasting service, who are now videotaping all of this in the back of the room. Colleen now oversees MCHCOM.com, the Center For the Advancement of Distance Education at the University of Illinois at Chicago. This is not a paid advertisement. But hello Colleen.
A prior project with our state system development initiative money, Colleen really led the development of focus on children first for children with special healthcare needs then we later became involved and broadened it to all children. And it is a very similar to like APEXPH or other kinds of manuals you can obtain, kind of walks you through step‑by‑step how do you organize a planning group, how do you collect secondary data primary data how do you feed it back, how do you help the group formulate plans and write objectives, all those kinds of things.
So mention that largely to say we made use of some material we developed with an earlier SSDI project. So each of the 10 and actually now 12 networks develops a strategic plan. We ask them to pick three to five priorities. Some of them pick 10. We sent that back and said, no, really seriously pick five. You won't be able to do 10. And those priorities are set in partnership with the community.
Here are the kinds of things ‑‑ we just finished our second round of that community planning process. And here are the kinds of things that are turning up in as community priorities. Outreach to physicians and other medical care providers to get them engaged in issues around families with young children. Running screening programs. Developmental screening. Sometimes in a way my frustration, the next do this as a very visible, very tangible and very useful thing in order to identify kids who need to be served and get them especially into Part C system. Development of parent education. Activities to make families aware of what's important about early childhood development and services that are available in the community. And work, work, work on the coordination of the ‑‑ coordination of the coordination and referral process within the communities.
Here's where we are ‑‑ here's where we are right now. If I went back to ‑‑ I think I'll go back. I have a button. I can go back. Back to the theory of change. What we're trying to do right now and this has taken about as long as that logic model did that we finally disposed of is to pick one or two indicators for each piece of the logic model for each of the five domains. So what we're going to ask the networks to collect, not necessarily report to us, but to collect so that they understand the operation of the local system and can diagnose problems with it. What should we take? We take healthcare services because it's probably the simplest and one of the ones we're most familiar with. So we're asking, we're working with the networks to identify an indicator that looks at, tells you whether or not you have enough healthcare providers in your community. So pediatrician to population ratio. Pediatrician to kids under age three ratio, something like that.
An indicator that talks about your effort to inform families of available services, and that becomes counting the distribution of materials. Most of the networks have developed what they call a family yellow pages. It's a compilation of information ‑‑ everybody who is a provider in the community, all want to inform of the available services everybody wants to be in the family yellow pages. We hand them out like it's welcome wagon stuff for families with newborns. Gather information on the (inaudible) who better to ask than families? What problems did you have getting into services? Language, time, location, hours; your treatment once you got there, all those kinds of things.
An indicator of whether or not the service coordination system is working well. And then we have oodles of indicators about service delivery, lots of EPSTD data we can look at for at least the Medicaid eligible kids and what kind of volume of service are they getting. Health status indicators we crank those out by the pound and family satisfaction which has been a new, we have to sort of keep pushing the networks to do this. And some of them have tried really very, very hard and even replicated strategies that have worked in other communities that have just fallen flat. Like we say go you want to get families point of view, go to some child care centers and do a short discussion with a few families waiting to pick up their kids or drop them off and take food. And some places that work and other places it's not been a successful strategy at all. So this has been a community by community, figure out what's going to work well to get you to talk to parents.
We have a small community of about 20,000 (phonetic) in the northwestern part of Illinois. Shreveport. Something of Illinois geography, it's west of Rockford. And our AOK network coordinator there meets with a different group of parents every month.
The community is that organize or parents in that community are that organized. There are that many parent groups she goes to a different one every month and talks to the parents about the basic three or four questions what are you liking, what are you not liking what are you having problems getting. So she's got this great feedback loop from parents to our community back to the service system because she convenes all those providers monthly or quarterly. This is what parents are telling me about what's working or not.
So we're in the process of picking indicators for each of those elements of the theory of change for each of the five domains so that when hey net ‑‑ not necessarily we in Springfield, but the network coordinator or the network as a whole takes and looks at that set of information should tell them whether or not they've got a well organized, well functioning adequately resourced system that's going to result in families to learn.
Now, back to where was I? Okay, some of the other kinds of concrete things that the networks do. A great deal of activity to provide information about available services, inform families what's going on, what's available. Screening activities to identify kids who need to be in services working with providers to make sure that families multi‑need families get services coordinated. Public education to tell parents. Success By Six was a marvelous example of this. Obviously we didn't do Success By Six, but that's the kind of thing we're thinking about. Doing broad‑based things to inform parents about why is child development important and a lot of effort goes into work force training and staff development and this is largely workshops. This is half day, day‑long kinds of things for some group of service providers in the community.
So we've distributed. That's supposed to have another zero that first dot point. 50,000 service directories, increase volume of screenings, coordinating home visiting services.
Cane County Illinois, two counties west of downtown Chicago. It's one of the wealthiest in the United States. It has 8,000 births a year, five hospitals at which you can be born and nine home visiting programs. And one of the things that the AOK America undertook was get all nine while the other eight because they ran one or two of them. Get people from all those nine home visiting programs in the same time same room at the same time saying there's 8,000 kids being born in this county every year and there's only nine of us and we only have about 500 spots among us. How are we going to sort this out so we don't send two of us to the same family? Which made a great deal of sense to everybody until you got into the details.
They finally did succeed. They developed, they developed sort of a rotation system to figure out who belongs in what kind of a home visiting program and the program representatives now get together with some regularity to make sure that the communication lines stay open and they get farmed out to the right kind of home visiting program.
We've been working a lot on transitions between Part B and Part C in early intervention. Getting the schools and EIS providers, talking to one another. Doing a variety of things to address gaps in services. Public awareness I touched on. Work force training I touched on. At the state level, we're one of the build initiative states, so that really provides the lion's share of our early child care collaboration. We recently got statutory authority for our state level collaboration which is now called the Early Learning Council. We have one of the ABC2 projects, a couple of the local demonstrations are also in AOK network communities. We recently became involved with the Strengthening Families Initiative. Some of its local sites are AOK communities. We also have a statutorily authorized children's mental health partnership. So several things going on at the state level in which these AOK connect.
And we are in 12 places. Let me see, two in Cook County one the community of North Lawndale. Any who are management school types, if you remember hearing about the Hawthorne studies, or Hawthorne effect, the General Electric plant where all that research was done was in North Lawndale. It has more challenges as a community than it did back in those days. And the Cook County suburb of Cicero, which is right next to it, down state. Cane County, which I talked about, and Stephenson County, which I talked about, Caswell County, McClain County where Bloomington is, where Danville is and Macon where Decatur is. Adams is a relatively rural county and Wabash and Edwards County in Illinois county is down at the far ‑‑
We then also added, (inaudible) which is right about here. That's where Joliet is and St. Claire County, where east St. Louis is, one of the most economically devastated communities in the whole U.S. of A.
We originally funded the 10 networks of the Illinois state Board of Education recently joined us this year in funding the two new ones. So there you have that. I think I have one more. I thought I had a question slide which would be been convenient, but it's not there.