Family Health ServicesFamily Health ServicesOklahoma State Oklahoma State
Department of HealthDepartment of Health
Institute on Child Welfare for Governors’ Health and Human
Services Policy Advisors
Edd D. Rhoades, MD, MPH
June 16, 2005
PUBLIC HEALTH AND CHILD ABUSE PREVENTION IN OKLAHOMA
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Public Health Tradition
• Prevention Focus - reduce conditions associated with child abuse and neglect before it occurs
• Multi-level Strategies - programs to strengthen communities and families, train professionals, and increase public awareness
• Statewide Approach - needs assessment, best practices, evaluation, service accessibility and accountability
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hPublic Health - Human Services
ContinuumPrimary Secondary Intervention Tertiary Prevention Prevention PreventionEducation Behavior Modification Reports Imposed TreatmentPublic Awareness Voluntary Home Visits Investigations Out of Home PlacementVoluntary Home Visits Center-Based Services Recommended TreatmentReunification Services
Adoption
Oklahoma State Department of Health Office of Child Abuse PreventionPublic Campaigns Family Resource and Support Child Abuse Training
Multidisciplinary Teams
Children First Program
Oklahoma Department of Human Services Children and Family Services High Risk Pilot Program Family Preservation Family Reunif ication
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Family Support and Prevention Service
• Office of Child Abuse Prevention
• Child Abuse Training and Coordination
• Community-based Child Abuse Prevention Grant
• Children First Nurse Family Partnership
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Child Abuse Prevention Act 1984
• Proclaiming child abuse in Oklahoma a public health crisis and declaring prevention a priority
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Office of Child Abuse Prevention
• Child Abuse Prevention State Plan
• State Interagency Task Force
• 17 District Task Forces
• Community-based child abuse prevention projects
• Training, technical assistance, evaluation, and quality improvement
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Community-based Projects
• Criteria – Mother may enroll prenatally or up to
three months postpartum – Families that qualify for C1 do not enroll
in OCAP unless C1 is at capacity– OCAP not restricted to first-time mothers
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Community-based Projects
• Services provided by community service contractors or health departments prenatally and up to the child’s fifth birthday
• Healthy Families Critical Elements• Parents As Teachers Curriculum• Services available through 21 sites –
not statewide
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Community-based Projects
• Services Provided– Homes visits– Center-based support and education
groups– Family Events– Child development assessments– Links to community resources
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Counties served exclusively by SFY2005 CAP Fund Contractors
TEXASCIMARRON BEAVERHARPER
WOODS
WOODWARD
ELLIS
WA
SH
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TO
N
GRADY
PO
TTAW
ATO
MIE
LINCOLN
MCCLAIN
ALF
ALF
A
GRANT
GARFIELDMAJOR
DEWEY
CUSTER
WASHITABECKHAM
ROGER MILLS
BLAINE
CADDO
CANADIAN
KINGFISHER LOGAN
PAYNE
CREEK
OKFUSKEE
OK
MU
LGE
E
HUGHES
PONTOTOCGARVIN
STEPHENS
COMANCHE
KIOWA
JACKSON
TILLMAN
COTTON
JEFFERSON
LOVE
CARTER
GREER
HA
RM
ON
MARSHALL
BRYAN
ATOKA
COAL
PITTSBURG
LATIMER
PUSHMATAHA
CHOCTAW
MCCURTAIN
LEFLORE
SEQUOYAH
MUSKOGEE
CH
ER
OK
EE
AD
AIR
DE
LAW
AR
EO
TT
AW
A
MAYES
RO
GE
RS
NO
WA
TA
WAGONER
TU
LSA
HASKELL
OSAGE
PAWNEE
KAY
NOBLE
OKLAHOMA
CLEVELAN
D
MURRAY
JOHNSTON
CRAIG
SE
MIN
OLE
Counties included In Districts:
I Pittsburg, Haskell, Leflore, Latimer
II Adair, Cherokee, McIntosh, Muskogee, Okmulgee, Sequoyah, Wagoner
III Cleveland, Coal, Garvin, McClain, Pontotoc
IV Canadian, Kingfisher, Logan
V Hughes, Pottawatomie, Seminole
VI Caddo, Comanche, Cotton, Grady, Jefferson, Stephens
VII Oklahoma
VIII Greer, Harmon, Jackson, Kiowa,Tillman
IX Beckham, Blaine, Custer, Dewey,Roger Mills, Washita
X Beaver, Cimarron, Ellis, Harper, Texas, Woodward
XI Creek, Lincoln, Okfuskee, Pawnee, Payne
XII Tulsa
XIII Craig, Delaware, Mayes, Nowata, Ottawa, Rogers, Washington
XIV Alfalfa, Garfield, Grant, Major, Woods
XV Carter, Johnston, Love, Murray
XVI Atoka, Bryan, Choctaw, Marshall, McCurtain, Pushmataha
XVII Kay, Noble, Osage
SFY 2005 COMMUNITY-BASEDSFY 2005 COMMUNITY-BASEDFAMILY RESOURCE AND SUPPORT PROGRAMSFAMILY RESOURCE AND SUPPORT PROGRAMS
BY DISTRICT AND COUNTIESBY DISTRICT AND COUNTIES
I
IIIV
V
VI
VII
VIII
IX
X
XI
XIIIXIV
XV
XVI
XVII
XII
SFY2005 Contractors
III
Counties served exclusively by the Chickasaw Nation and the Comanche Nation of Oklahoma
County served by CAP Fund Contractor and Comanche Nation Tribe
MCINTOSH
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Community-based Projects
• State Fiscal Year 2004– 1,052 families received home visitation– 15,421 home visits were completed– 978 families received center-based
services
• Funding $2.68 million
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hChild Abuse Training and
Coordination
• Child Abuse Training and Coordination Council
• Multidisciplinary and discipline-specific training
• Multidisciplinary team (MDT) training
• Technical assistance to MDTs
• Assessment of multidisciplinary teams
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TEXASCIMARRON BEAVERHARPER
WOODS
WOODWARD
ELLIS
WA
SH
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TO
N
GRADY
LINCOLN
ALF
ALF
A
GRANT
GARFIELD
MAJOR
DEWEY
CUSTER
WASHITABECKHAM
ROGER MILLS
BLA
INE
CADDO
CANADIAN
LOGAN
PAYNE
CREEK
OKFUSKEE
OK
MU
LG
EE
HU
GH
ES
PONTOTOC
STEPHENS
COMANCHE
KIOWA
JACKSON
TILLMAN
COTTON
JEFFERSON
LOVE
CARTER
GREER
HA
RM
ON
MARSHALL
BRYAN
ATOKA
COAL
PITTSBURG
LATIMER
PUSHMATAHA
CHOCTAWMCCURTAIN
LEFLORE
SEQUOYAH
MCINTOSH
MUSKOGEE
CH
ER
OK
EE
AD
AIR
DE
LA
WA
RE
OT
TA
WA
MAYES
RO
GE
RS
NO
WA
TA
WAGONER
TU
LS
A
HASKELL
OSAGE
KAY
NOBLE
MURRAY
JOHNSTON
CRAIG
SE
MIN
OLE
Multidisciplinary Child Abuse and Neglect Teams, Oklahoma, SFY 2Multidisciplinary Child Abuse and Neglect Teams, Oklahoma, SFY 2004.004.
I
IIIV
VVI
VII
VIII
IX
X
XI
XIIIXIV
XV XVI
XVII
III
OKLAHOMA
Established Team
Source: Oklahoma State Department of Health, Office of Child Abuse Prevention
XII
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hCAPTA (Title II) Community-based Child Abuse Prevention (CBCAP)
• Support community-based efforts to develop, operate, expand, enhance, and, where appropriate, to network, initiatives aimed at the prevention of child abuse and neglect,
• Support networks of coordinated resources and activities to better strengthen and support families, and
• Foster an understanding, appreciation, and knowledge of diverse populations
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hCommunity-Based Child Abuse
Prevention Activities
• Training and technical assistance• Respite services• Fatherhood Initiative• Native American home visitation services• Evaluation• Network coordination• Public education• Oklahoma Funding FFY 05 approximately
$900,000
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NURSE FAMILY PARTNERSHIP
THREE GOALS
1. Improve pregnancy outcomes
2. Improve child health and development
3. Improve parents’ economic self-sufficiency
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NURSE FAMILY PARTNERSHIP
CONSISTENT RESULTS ACROSS TRIALS
• Improvements in women’s prenatal health
• Reductions in children’s injuries
• Fewer subsequent pregnancies• Greater intervals between births
• Increases in fathers’ involvement
• Increases in employment • Reductions in welfare and food stamps
• Improvements in school readiness
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NURSE FAMILY PARTNERSHIP
Elmira Trial 56% Reduction in Emergency Room
Visits (12-24 Months)
80% Reduction in Child Maltreatment(Poor, Unmarried Teens)
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NURSE FAMILY PARTNERSHIP
NATIONAL REPLICATION
• Now operating in over 250 counties in 23 Now operating in over 250 counties in 23 states serving over 12,000 families per states serving over 12,000 families per year.year.
• Children First – Oklahoma’s Nurse Children First – Oklahoma’s Nurse Family Partnership established in 1997Family Partnership established in 1997
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Children First • Public health nurses provide
home visitation to parents expecting to deliver and/or parenting their first child
• Based in county health departments with services delivered in every county
• Mothers must be enrolled prior to 28 weeks of pregnancy and low income (185% FPL)
• Research based practice
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Children First
Services• Child and maternal health assessments• Child development screenings• Parenting education• Health, safety, and nutrition education• Linking families with health care, child care,
mental health services, job training, and other community services
• Information and referral services
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Children First
Prevention Outcomes• OUHSC evaluation concluded that Children
First (1998-2001) prevented:– 22 very premature births– 14 very low birthweight babies– 24 infant deaths
• Babies born to C1 mothers were at about one-half the risk of death within the first year of life compared to babies of non-C1 mothers
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Services SFY 2004• 5,869 families
received services• 56,426 home
visits were made• Funding
State $10.9 million
• Federal $800,000
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Smart Start Oklahoma
• HB 1094, the Oklahoma Partnership for School Readiness Act, in April 2003
• Coordinates private and public funds to support Smart Start communities
• Builds statewide public awareness of Oklahoma’s school readiness needs and solutions.
• State Partnership • Foundation• Smart Start Communities
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Smart Start OklahomaOutcomes• Oklahoma children will live in families where
adults nurture, teach and provide for them.• Oklahoma children will be born healthy and
remain healthy.• Oklahoma children will learn and play in
high quality child care settings when their families need those services.
• Oklahoma children will enter school healthy and equipped with the age-appropriate cognitive, emotional, pre-literacy and social skills needed for learning.
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Smart Start Oklahoma
• Department of Human Services Child Care Stars Program
• Dept of Education 4 Year Old Pre-Kindergarten Program
• Maternal and Child Health Early Childhood Comprehensive Systems Initiative
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CAPTA and Early Intervention
• Keeping Children Safe Act of 2003 amended CAPTA
• States required to develop “provisions and procedures for referral of a child under the age of 3 who is involved in a substantiated case of child abuse or neglect to early intervention services funded under Part C of the Individuals with Disabilities Education Act
• Procedures implemented in SFY 05 for referrals of children in Oklahoma
