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INTEGRATING HOME VISITING AND FAMILY SUPPORT SERVICES INTO AN EARLY CHILDHOOD SYSTEM OF CARE SIT/CHVP Workgroup November 6, 2014 Kiko Malin, Director Family Health Services Division Alameda County Public Health

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Overview Home visiting integration review and update Progress towards an early childhood system of care Addressing the social conditions that influence health Policy efforts at the county level

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Population Served 20,000+ Births in Alameda County Annually 6,600 Medi-Cal Births 1,500 Born Low Birth Weight At-risk African American Families ~50% Experience Breastfeeding Problems 6,000 Children 0-5 Have Contact with CPS 1,500 Births to Teen Mothers ~ 27% Postpartum Depression

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Programs involved in HV integration ACPHD Family Health Services programs Black Infant Health Alameda County Healthy Start Initiative (ACHSI, formerly IPOP) MADRE Special Start Healthy Families America (HFA, formerly Your Family Counts) Fatherhood Initiative Nurse Family Partnership First 5 contracts Special Start at UCSF Benioff Childrens Hospital Oakland Pregnant and Parenting Teen Programs (TVHC, Brighter Beginnings) Other ACPHD programs Asthma Start Public Health Nursing

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Healthy Start (ACHSI) Update Awarded grant in late August for Sept. 1 start ACHSI as component of a broader home visiting system was a critical part of grant proposal Three main components: Intensive case management for highest risk families (HFA) Family Health Promotion (ClubMom, care coordination) Womens Health Promotion (peer navigators, outreach) Will also take a place-based approach

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ClubMom Goal To positively change the CONTEXT in which young African American mothers make decisions around their health and related behaviors so that it includes: Social SUPPORT Health INFORMATION Knowledge of RESOURCES Health-seeking MOTIVATION

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TRANSITION YFC and ACHSI case management staff to Healthy Families America; HIRING new staff and supervisors BUILD OUT mental health services unit CONNECT families in the Best Babies Zone with home visiting services and other activities INSTITUTIONALIZE reflective supervision

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Current Focus REVIEW and OPERATIONALIZE evaluation framework developed by outside evaluator DEVELOP common standards and INCORPORATE into practice DESIGN and IMPLEMENT training and professional development plan ESTABLISH Family Advisory Committee

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Ultimate Goal NEST DIRECT SERVICES within both a broader early childhood system of care CONNECT families to supports and services that address the social determinants of health ADVOCATE at county level for support to sustain and expand home visiting services

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Alameda County Public Health Department Home Visiting- Family Support Steering Committe Family Advisory Committee Outreach and Triage Committee Alameda County Family Support System of Care Community Partnership ALAMEDA COUNTY HOME VISITING AND FAMILY SUPPORT SERVICES SYSTEM OF CARE GOVERNANCE Maternal Child Health/Early Childhood and Prevention/ Early Intervention Home Visiting Programs BBZ HFA ACHS I NFP First 5 and MPCAH Contract Coordination Executive Committee

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Current Focus of Community Partnership Developing position description for early childhood mental health liaison(s) Exploring possibility of dedicated benefits eligibility worker for home visiting Members from: Social Services Probation Early Head Start Alameda Health System First 5 Healthy Homes

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Ultimate Goal NEST DIRECT SERVICES within both a broader early childhood system of care CONNECT families to supports and services that address the social determinants of health ADVOCATE at county level for support to sustain and expand home visiting services

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OAKLAND HILLS LIFE EXPECTANCY EAST OAKLAND LIFE EXPECTANCY Compared to a White child born an African American child born in East Oakland can expect to live 15 fewer years. in the affluent Oakland Hills Photo Source: The California Endowment, Health Happens Here

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Source: Alameda County Death files, 2010-2012; Alameda County Birth files, 2009-2011; American Community Survey, 2007-2011; California Dept of Education, 2012-2013 Place, Income and Social Inequality Affect Health Across the Lifecourse 2X more likely to be born low birth weight 12X less likely to have a mother with a college degree 21X more likely to live in poverty 3X less likely to read at grade level 6X more likely to be unemployed 2.5X more likely to die of stroke INFANT CHILD ADULT Cumulative impact: 15 year difference in life expectancy

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Best Babies Zone: Castlemont Neighborhood There is a 13 year difference in life expectancy between a child born in Piedmont and a child born in Castlemont.

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Castlemont Best Babies Zone: Focus Areas Early Childhood and Family Supports Room to Bloom Early Childhood Hub Home Visits Community Engagement, Planning and Action Community Cafes East Oakland Innovators Mini-grants Building a Local Economy Community Market Youth Murals, Merchant Supports Foundational Work Communication Evaluation Partner Engagement

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Project HERA Overall Goal: Grow a unit in Maternal, Paternal, Child and Adolescent Health (MPCAH) that that engages staff and clients in developing solutions to the social factors that impact the health of families receiving our services.

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Build capacity of MPCAH staff to address financial issues with clients Advocate for low cost financial products for clients Engage MPCAH staff in identifying and addressing housing issues that impact their clients Develop a clear path for home visitors to communicate about policy-related issues they face in their work

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Leverage existing County funds to expand credit and financial opportunities Support small lenders in reaching underserved people Reduce predatory lending and associated financial and health consequences Remove the barriers to building wealth that disproportionately impact communities of color Alameda County Healthy Credit: Investing in Stability and Prosperity

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Ultimate Goal NEST DIRECT SERVICES within both a broader early childhood system of care CONNECT families to supports and services that address the social determinants of health ADVOCATE at county level for support to sustain and expand home visiting services

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Financing the Home Visiting/Family Support System of Care Existing Funding Streams: First 5 Alameda County ACPHD general funds Title V dollars Healthy Start grantee MIECHV monies TCM/FFP Funds are braided, in programs and positions Funding Opportunities to explore: Cross agency funding and leveraging opportunities Title IV-E Medi-Cal Managed Care Board of Supervisors investment

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Birth to 8 Statement of Purpose The Alameda County Birth to 8 Initiative is a catalyst to improve childrens 3 rd grade success and reduce health and education disparities. We work to improve outcomes by partnering with policy makers, county agencies and community stakeholders. Only 45% of kindergarteners in Alameda County are kindergarten ready

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Birth to 8 Recommendations to Improve Kindergarten Readiness Increase the following existing, cross-systems efforts: Early childhood home visiting Quality early care and education Early identification Bridge transitions between age groups, programs and systems and intensify mental health and parent leadership and support. Present funding request to Board of Supervisors next year

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Thank you! Questions? Kiko Malin, FHS/MPCAH Director Kiko.malin@acgov.org (510) 208-5979 Anna Gruver, MPCAH Coordinator Anna.gruver@acgov.org (510) 667-4334