3-year strategic plan - Ionia County Great Start Collaborative

Transcription

A Comprehensive Strategic Plan for
Early Childhood Development
in Ionia County
January 2014 - December 2016
1
Table of Contents
Guiding Principals……………………………………………….. 3
Letter to the Community ………………………………………… 4
Signature Page ………………….………………………………
5
Membership …………………………………………………….
7
Executive Summary …………………………………………….. 8
Guiding Principals ………………………………………………. 11
Great Start Collaborative Profile & History …………………….. 12
Strategic Analysis Findings ……………………………………... 14
Goals & Strategies ………………………………………………. 17
Action Agenda …………..……………………………………… 18
Financing & Fund Development ………………………………… 32
Appendices ………………………………………………………. 34
2
Guiding Principles of ICGSC
Description of a Family
We all come from families. Families are big, small, extended, nuclear, multigenerational,
with one parent, two parents, and grandparents. We live under one roof or many. A family
can be as temporary as a few weeks, as permanent as forever. We become part of a family
by birth, adoption, marriage, or from a desire for a mutual support. As family members, we
nurture, protect, and influence each other. A family is a culture unto itself, with different
values and unique ways of realizing its dreams; together, our families become the source of
our rich cultural heritage and spiritual diversity each family has strengths and qualities that
flow from individual members and from the family as a unit. Our families create
neighborhoods, communities, states and nations.
~ National Scientific Council Center on the Developing Child at Harvard University
Guiding Principles
Families in Ionia County are
accepted as they are and supported
to grow stronger. Families in Ionia
County are empowered to utilize
the knowledge, energy, health, and
resources that they have at any
given time. Families in Ionia
County are honored, promoted and
strengthened for their ethnic, social,
structural, and cultural identities.
Families in Ionia County are
resources to the members of their
families, agencies, and the
community as a whole. Decisions in
Ionia County will not be made without having consumer representation.
A community assessment, based on required components was conducted; community
conversations added a critical point-of-view to this process. The ICGSC updated the
strategic plan, based on identified community needs and to be reflective of the unique
makeup of Ionia County. The long term goal of the ICGSC is universal access to services
for every Ionia County child and their family from birth through kindergarten entry.
3
Letter to the Ionia County Community
ICGSC Members:
To Th e C o m mu n i t y,
Th e Io n i a C o u n t y G re at S t a rt C o l l ab o ra t i ve ( IC G S C ) h as b e en g r an t ed an
o p p o rt u n i t y t o h av e a p o s i t i ve i mp a ct o n t h e f u t u re o f o u r yo u n ge s t
ci t i zen s an d t h ei r f a mi l i e s . Th e f i rs t f i ve ye a rs o f a ch i l d ’ s l i f e c an r eap
t h e g re at es t i n ves t m en t i n o u r f u t u re. Th e f i rs t f i ve ye ar s o f a ch i l d ’ s l i f e
i s an o p p o rt u n i t y t o b u i l d a ch i l d ’ s b r ai n . Les s t h an ei gh t p e r cen t o f
p u b l i c i n ves t men t s o n ed u cat i o n , ch i l d d e v el o p men t , an d o t h e r s u p p o r t s
ar e t a r g et ed at t h i s a g e g ro u p ; wh i l e t h i s i s an i n c re as e f ro m f o u r p e rc en t ,
t h er e i s s t i l l w o r k t h at w e can d o . It i s f o r t h i s r e as o n t h e Mi ch i g an E ar l y
C h i l d h o o d In v es t men t C o rp o r at i o n ( EC IC ) i n i t i at ed t h e G r eat S t a rt
s ys t e m t o as s u r e a co o rd i n a t ed s ys t e m o f co m mu n i t y r es o u r ce s an d
s er v i c es t o h e l p al l Mi c h i g an f a m i l i es wi t h ch i l d ren f ro m b i r t h t o a g e
ei gh t . IC G S C h as b e en w o r ki n g t o s ecu re t h i s s ys t e m f o r t h e l as t f o u r
ye a r s .
Th e IC G S C w as f o r m ed f o u r ye a rs a go as a l o ca l p l an n i n g an d d ec i s i o n
ma k i n g b o d y f o r t h e G r eat S t ar t S ys t e m. P res en t l y, t h er e ar e 5 4 Gr ea t
S t a rt C o l l ab o rat i ves i n Mi ch i gan . In o rd e r t o m o re ef f e ct i v el y me et t h e
n eed s o f ch i l d ren an d f am i l i es , t h e IC GS C co n d u ct s co m mu n i t y
as s es s m en t s an d d e vel o p s an d u p d a t es a S t ra t e gi c P l an b as ed o n t h e
f i n d i n gs o f an an n u al s ys t e m a s s es s m en t . Th i s wi l l b e t h e s e co n d
s t r at e g i c p l an w e h a v e i mp l e men t ed . IC G S C b o ard m e mb e rs a re
co m m i t t ed t o p ro v i d i n g co n t i n u ed l e ad e rs h i p s u p p o rt f o r acco mp l i s h i n g
t h e i d en t i f i ed go al s o f t h e Io n i a C o u n t y G re at S t a r t C o l l ab o r at i v e.
S u p p o rt i n g p a r en t s mat t e rs b ec au s e p ar en t s a re t h ei r ch i l d ’ s f i r s t an d b es t
t ea ch e rs . Th e IC G S C w an t s t o co n t i n u e wo r ki n g o n d e v el o p i n g t h e b es t
f o u n d at i o n p o s s i b l e f o r o u r yo u n g es t co m mu n i t y me mb er s . C h i l d ren wh o
h av e ap p ro p ri at e med i ca l ca r e, co n s i s t en t an d s e c u re c ar e gi ve r, ad eq u at e
n u t ri t i o n , an d a v a ri e t y o f ed u cat i o n al o p p o rt u n i t i es s u ch a s b ei n g re ad t o
o r at t en d i n g p r es ch o o l a r e mo re l i k el y t o s u c ce ed i n s ch o o l an d l i f e. B y
i n s i s t i n g o n q u a l i t y s er v i ces an d i mp ro vi n g co l l ab o rat i o n o f t h e s e r vi ces
an d r es o u r ce s cu r ren t l y a va i l ab l e t o f a m i l i es , t h e go a l i s t o m a xi mi ze t h e
i mp act o f f ed e ra l , s t a t e an d l o c al r es o u r ces t o b en ef i t ch i l d r en an d t h e i r
f ami l i es . B y a g e s i x, 9 0 % o f a ch i l d ’ s co r e b r ai n s t ru c t u r e i s f o r med .
S ad l y, l es s t h an 4 % o f p u b l i c i n ve s t men t s o n ed u ca t i o n , ch i l d
d ev el o p men t , an d o t h e r s u p p o rt s a r e t ar g et ed at t h i s a ge gro u p .
Th an k yo u f o r t a ki n g t i m e t o u n d ers t an d t h e go al s , amb i t i o n s an d p u rp o s e
o f t h e IC G S C . Th e IC G S C m e mb e rs p rep ar ed t h i s p l an t o p r es en t t h e
co m mu n i t y w i t h o u r v i s i o n , mi s s i o n an d act i o n a gen d a. Th e d a t a
p res en t ed co mes f ro m a va ri et y o f s o u rc es u s i n g t h e l at e s t d a t a a va i l ab l e .
W e w an t t o kn o w yo u r p ers p ec t i ve o n h o w we ca n s u p p o rt yo u an d yo u r
f ami l y i n ge t t i n g yo u r ch i l d o f f t o a g rea t s t a rt . P l eas e c al l 6 1 6 - 5 2 2 -1 4 1 2
o r ch e ck o u r w eb s i t e a t G r eat S t ar t Io n i aC o u n t y. o r g t o b eco m e i n vo l v ed i n
IC G S C act i vi t i es . We g r e at l y v al u e t h e co l l ab o ra t i o n i t t a kes t o s u s t a i n a
co o rd i n at ed ef f o r t t o co n t i n u e t o b u i l d h ea l t h y, s t ro n g, an d s af e
co m mu n i t i es f o r o u r f a mi l i es . We i n v i t e yo u t o j o i n u s i n o u r ef f o rt s !
S i n c er el y,
C ar i O ’ C o n n o r, LM S W
Io n i a & Mo n t ca l m C o u n t y G r ea t S t a rt C o l l ab o ra t i ve
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Dr. Kathleen
Ellsworth, DDS
The Crayon Box
Daycare
Kids World
Daycare
Parents
First Bank
Enrich
Temple Baptist
Church
Ionia County
Health Department
EightCap
ICSAI
RAVE
Ionia County
Department of
Human Services
Ionia County ISD
Ionia Public
Schools
Saranac
Community Schools
United Way
of Ionia County
Ionia County
Juvenile Court
Ionia County
Memorial
Hospital
Ionia County
Economic Alliance
Ionia County
Community
Mental Health
Ionia County Friend
of the Court
Catholic Charities
West Michigan
Ionia County
Literacy Council
Central Region
Resource Center
For Health Family
Resource Center
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Membership
Dr. Dorothy Berg
Andrea Booker
Dr. Beau Brainard , M.D.
David Cook
Dr. Kathleen Ellsworth
Amanda Ferris
Traci Flanner
Cheryl Granzo
Elijah Harris
Heather Jackson
Christa Jerome
Bob Kjolhede
Heather Knapp
Robert Lathers
Darin Magley
Josh Mason
Lisa McCafferty
Kevin Meade
Tabatha Mitchell
Nancy Sherd
Cari O’Connor
Robert Ranney
Keegan Rice
Erin Roberts
Jessica Rowland
April Ruehs
Nancy Secor
Michelle Seigo
Jason Smith
Hon. Robert Sykes
Deb Thailson
Roger Thelen
Laurie Tjalsma
Deborah Trierweiler
John VanNieuwenhuyzen
Danielle West
Norine Andrews
Nicole Marzic
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Executive Summary
The Ionia County Great Start Collaborative (ICGSC) has engaged many service providers,
parents, and community members to support the mission and vision of the ICGSC. These
statements guide our work as we continually assess our progress. We review the current
data and state of our county to ensure that our vision becomes reality for birth to eight
children and their families.
Mission:
To develop a seamless system of care
that utilizes community resources and supports,
to help our families have access to the
tools needed to provide a healthy start for all
children birth to kindergarten entry.
Vision:
Children in Ionia County are healthy, eager,
and prepared to succeed in school and life.
Our community assessment revealed data that indicated great challenges for many
young children and their families. In Ionia County, we have seen a decline in our child
population, however more of our children are living in poverty than ever. This would
indicate that many families are having trouble meeting economic basic needs. Also the
higher percentage of families eligible for temporary assistance for needy families (TANF)
mean that the time limits on benefits through the Department of Human Services in 2012
had a big impact in our communities. Ionia County had the highest percentage drop in FIP
cases of all Michigan counties, with a 48% drop.
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Executive Summary
Basic economic needs like food and shelter continue to be a theme in our community
conversations. Medical and dental assistance were areas that families continue to struggle
with; also in Ionia County, we saw a 2.8% increase in our babies being born without or only
late prenatal care. This data also shows Ionia County is higher than the state average
(13.9%) having people with out health insurance at 14.9%. Families without health
insurance are still using emergency room services to address their medical an dental needs.
Concerning areas (higher than the state average statistics) for our children in Ionia County
also involve physical and social emotional health. We continue to have a higher number of
obese children at 15.4%. Economic woes seem to start at birth with 46% of births in Ionia
County being paid for by Medicaid. This means that 46% of children are born into poverty
in Ionia County. We have seen a dramatic increase in the number of children birth to five
where these is substantiated child abuse and neglect. Up from 18.25% to 25.7% in the most
recent reported years, We are above the state average of 13.8% by 11.8%. Ionia County
also has a 49.6% rate of children in K-12 that are eligible for free or reduced school lunch
programming. Basically, almost half of our school age children are born and continue to
live in poverty.
Substance abuse continues to be on the rise along with our cases of neglect and abuse. In a
national study, 50 to 80 percent of the child abuse and neglect cases dealt with parents or
care givers with substance abuse issues. Children living in these circumstances often arrive
at kindergarten unprepared and those that start behind are more likely to stay behind.
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Executive Summary
Ionia County continues to bring many forces together to lay a strong foundation for our
children. For the last three years the members of the ICGSC have met tighter to attempt to
find solution to basic needs supports, homelessness, lack of preschool opportunities, limited
access to health care, access to healthy living supports, and teen pregnancy.
Great strides have been made in Ionia County. The percentage of Women's infant and
children program reported overweight or at risk of being overweight is down from 2011.
Ionia County has seen a decrease in teen parent population for the first time in many years.
Repeat teen births are also down by 4%. Immunization rates continue to be over the state
average at 81%. Low weight at birth is below the state average as well. More free or reduced
cost preschool opportunities are available than ever before. ICGSC has joined forces with
several initiatives to bring birth to eight families to the fore front. The Ionia County
Substance Abuse Initiative, the Ionia Health Plan, and 211 initiatives are just a few examples
to the partnerships established with the ICGSC in an effort to have a positive impact on the
lives of families in Ionia County. The highest priority continues to be the provision of quality
services and supports for birth to eight families in Ionia County.
The ICGSC is independently evaluated through Michigan State University every two years.
2012 ICGSC evaluation results were impressive. The strongest areas of our ICGSC work
according to the survey participants were intentional systems change actions, establishing
effective partnerships, and building parent leadership in our community. Areas that we will
target for improvement were creating a strong relational network and increasing the number
of active constituents in the ICGSC work. The ICGSC improved in all fourteen outcomes
from 2010. All levels of change for building a strong early childhood system saw significant
improvements. The ICGSC results for authentic parent voice and movement in all the levels
of change were recognized at the state level.
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Guiding Principles
Families in Ionia County are accepted as they are and supported to grow stronger.
Families in Ionia County are empowered to utilize the knowledge, energy, health, and
resources that they have at any given time.
Families in Ionia County are honored, promoted and strengthened for their ethnic, social,
structural, and cultural identities.
Families in Ionia County are resources to the members of their families, agencies, and the
community as a whole.
Decisions in Ionia County will not be made without having consumer representation.
A community assessment, based on required components, has been conducted; community
conversations added a critical point-of-view to this process. Enclosed in this document is a
completed strategic plan, based on identified community needs and reflective of the unique
makeup of Ionia County. The long term goal of the ICGSC is universal access to services for
every Ionia County child and their family from birth through kindergarten entry.
Child development professionals, special educators, social workers, health care providers and
support staff all agree that the Ionia County Great Start Collaborative have the level of
collaboration and coordination of early education and care opportunities available for Ionia
County’s youngest children. From board members to front line workers, the highest priority
continues to be the provision of quality services to birth to five population.
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Profile
The Ionia County Great Start Collaborative (ICGSC) has created a foundation
that ensures that all children in Ionia County arrive to kindergarten healthy, safe,
and ready to succeed in school and life. Years of previous efforts, commitment,
and interagency collaboration have helped lead the way in creating this
foundation. The Ionia County Great Start Collaborative membership consist of
parents, public health, human services, community mental health administrators,
k-12 system representatives, preschool representatives, child care providers,
charitable organizations, business leaders, faith based leaders, elected and public
officials, minority leaders, and other community leaders. These partners are
dedicate to creating a quality early childhood system in Ionia County.
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Profile
Highlights and Accomplishments
 August 2008 - Ionia County Intermediate School District applied for the Great Start
Collaborative Start Up Grant.
 September 2008 - Ionia County ISD was awarded the Great Start Collaborative Start Up Grant.
 October 2008 - Formal Interagency agreements were signed.
 December 2008 - Formation of Executive Committee of the ICGSC with Operating
Guidelines.
 November 2008 - The Great Start Collaborative committee needs identified.
 December 2008 - GSC communications Committee formed, public relation/outreach of the
importance of early childhood supports and system planning implemented.
 December 2008 - First Formal ICGSC meeting held.
 January 2009 - The Parent Coalition of Ionia County developed.
 May 2009 - The first Parent Coalition meeting was held.
 May 2009 - The ICGSPC attended their first Star Power Day.
 November 2009 - First of many Mom 2 Mom sale held in Ionia County.
 December 2009 - The ICGSPC host their first annual Reading with Santa event.
 December 2009 to October 2010 - Strategic Planning process for ICGSC occurred.
Plan Approved.
 May 2010 - Star Power Day.
 August 2010– First Ice Cream Social was held in partnership with Eight Cap Inc.
 September 2010- First Kindergarten Round up surveys were completed and report distributed.
 November 2010 - ICGSPC hosts a candidate forum.
 November 2010 - The ICGSPC won the Cool Communities Contest through Michigan 1.
 February 2011 - ICGSPC toured the Capitol and Legislator Mike Callton’s office.
 March 2011 - The first Parenting Awareness Month activity was held.
 May 2011 - The ICGSPC was awarded the Fierce Heart Award at Star Power Day.
 August 2011 - Ice Cream Social held in partnership with Eight Cap Inc.
 September 2011 - Virtual Bus tour was completed and distributed to all community leaders.
 October 2011 - The ICGSC Director position merged with the Montcalm County GSC.
 January 2012 - The ICGSPC becomes the planning committee for Parenting Awareness Month
Activities.
 March 2012 - 2nd Annual Parenting Awareness Month Activity is held with legislator
 April 2012 - First Touch a Truck event held.
 May 2012 - Star Power Day.
 May 2012 - ICGSC participates in local community garden efforts.
 August 2012 - Annual Ice Cream Social in partnership with EightCap Inc.
 October 2012 - The ICGSPC holds their first Parent Café.
 November 2012 - The ICGSPC won the Cool Communities Contest through Michigan 1.
 January 2013 to October 2013 - Strategic Planning
process for the ICGSC Occurred. Plan Approved.
 March 2013 - Annual Parent Child Dance held.
 May 2013 - Star Power Day
 August 2013 - Annual Ice Cream Social in partnership with EightCap Inc.
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Strategic Analysis Findings
The Ionia County Great Start Collaborative collected and reviewed data specific to our
community in the area of Community Conditions, Early Care and Education, Family
Support, Physical Health Care and Social Emotional Health. This data collection
included complied surveys from Kindergarten Roundup in all five school districts, a
Health Status Assessment from the Sparrow Ionia Hospital and 20 Community
Conversations with over 200 birth to five parents participating, to gain the perspective
of our partners on current community conditions and priorities for the five subject
areas. What we learned for each:
Community Conditions of Ionia
While there are fewer children in Ionia County compared to the 2005 Census data, the
economic security of children in Ionia County has worsened since the last Strategic
Review for most indicators. More children are in poverty, more are receiving free or
reduced lunches at school, and more are receiving SNAP food assistance than in 2007.
Despite this growing economic hardship, Ionia County reported the greatest percentage
drop (of 48%) in families receiving FIP Cash Assistance through DHS. Finally,
unemployment in Ionia is at 8.3% for 2012, compared to a pre-recession 7.2% in 2005.
These community conditions are the reason, the ICGSC set a high priority for
supporting families through initiatives to make affordable and accessible family
supports such as basic needs supports, including physical, social and emotional health
available, and affordable, quality early education and child care.
On the community health conditions, there was more of mixed results in trends. Ionia
County has seen a decrease in teen parent population, with repeat teen births down by
four percent. There is also a reduced percentage of WIC children classified as either
overweight or at risk of being overweight in 2012 compared to 2011. There is an
increase in immunization rates-- which at 81.0% for those 15 to 35 months, is higher
than the state rate of 75.0%. Unfortunately, the county DHS data shows a dramatic
increase in the number of children age 0 – 5 where substantiated child abuse and neglect
has been reported – 25.6%, up from 18.25%. This is substantially higher than the
statewide average of 13.8%. Overall, more persons in Ionia are without health insurance
(at 14.9%) than statewide (at 13.9%). Overall, obesity in children is also higher in Ionia
than statewide.
Early Education and Child Care Factors
Two themes emerged from the community conversations on Early Education and Child
Care Factors. The Ionia community believes strongly in early care and education being a
key to future success. As such there is a high priority to have quality early childhood
education opportunities available to all, including those facing economic hardships.
Having more preschool available was the second highest ranked factor identified by
Café Conversation participants on what is needed to improve children’s school
readiness. Early Childhood programming was ranked highest for what participants felt
the community could do better on. Increasing playgroup opportunities also came up
during this strategic planning process and our last strategic planning process.
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Results also clearly expressed that parents are the key to child readiness. Parents have to
believe early childhood education matters and have, as parents, the skill sets to do their part.
Ionia stakeholders identified continued advocacy to support expanding quality early
childhood education opportunities in Ionia County as important to providing access.
Parents being ready with these skills was ranked as the top factor in improving school
readiness by Café Conversation participants. Budget cuts to early education and family
supports are the third highest challenge facing the community according to the Café
Conversation participants.
Family Support Factors
With the emphasis on the parents’ role in early childhood development and the economic
insecurity of a significant portion of families in Ionia, the community identified a lack of
supports for families to have access to the skills and training they need to do their part in
quality childhood development. This included a need to do more to connect and link parents
to current resources and well as expanding resources available to meet parents’ needs. Lack of
knowing resources available was identified as the biggest challenge by the Café Conversation
participants. Funding for 211 continues to be an issue. This could leave 180 plus families
without resources and referral information.
Physical Health Factors
The community strongly believes that healthy children are key to having a successful future.
The biggest challenge to this future success identified by Café Conversation participants was
obesity rates for children, but dental health, mental health and immunization rates were also
mentioned. The documented significant increase in abuse and neglect cases in Ionia County
was identified as a new health factor that needed to be addressed, as was bullying. The lack
of access to health care for families (from the health indicator of above statewide rates of
uninsured) was also identified as a barrier to achieving the health families deserve. Lack of
insurance and health care that needs to be addressed, particularly through increased
partnerships.
Social Emotional Health Factors
Access to social emotional support, particularly access to mental health services was
identified as an area the community needed to do better on by Café Conversation participants.
Two new social emotional health factors identified through the data gathering process was the
need to address bullying of children and the need to address the
social and emotional impact of the high abuse and neglect cases
substantiated within Ionia County. As identified by participants,
the social and emotional supports need to be available to parents
as well as children. Ionia County has seen an influx of providers
of mental health services in the past 3 years, yet it is still labeled
as a mental health provider shortage area.
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Priorities and Pressing Issues for Ionia County Children ages birth to 8
Wellness
 Childhood Obesity
 High numbers Confirmed Abuse and Neglect Cases
 Lack of supports for Social Emotional Development
 Substance Abuse Concerns
Family Support
 Need more Parent Support for basic needs: employment,
early literacy supports, health care, family support and
access to early childhood education supports.
Early Education and Child Care
 Lack of affordable, Quality Preschools for 3 year olds
 Need more affordable, local opportunities to improve quality
for child care providers
 Lack of access to quality child care providers
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Goals and Strategies:
Goal 1:
Maintain the infrastructure of the ICGSC.
 Objective 1: Maintain engagement and effectiveness of the ICGSC
Board.
 Objective 2. Educate Ionia County Communities about Early
Childhood Investment.
 Objective 3. Create blended funding opportunities in Early
Childhood system in Ionia County.
 Objective 4. Maintain a coordinated early childhood advocacy
message in Ionia County.
Goal 2:
Improved wellness for children prenatally through age eight.
 Objective 1: Develop wellness supports for birth to eight
families in Ionia County.
 Objective 2. Improve wellness supports access for birth to
eight families.
 Objective 3. Build partnerships to create family support
opportunities.
Goal 3:
Children in Ionia County are prepared to succeed in school.
 Objective 1: Create affordable opportunities for families to support
their needs.
 Objective 2. Promote affordable, quality preschool experiences in
Ionia County.
 Objective 3. Build partnerships to promote educational
opportunities for caregivers
Goal 4:
Families support and guide the learning of birth to eight children.
 Objective 1: Build parent supports into the Ionia County Early
Childhood System.
 Objective 2: Strengthen collaboration between referral sources.
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Action Agenda
The action agenda is in a grid format and covers
the following for each identified goal:
Strategy
 Objective
 Resource Needs
Roles and Responsibilities
 Target Dates


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Goal 1: Maintain the infrastructure of the ICGSC.
Office of Great Start Outcome: Children healthy, thriving, and developmentally on
track from birth to grade three.
Strategy 1: Maintain engagement and effectiveness of the ICGSC Board.
Action Steps
a) Maintain Membership Corner
b) Develop Parent Board member
recruitment tools; including web based
tools
Resource
Needs
Staff time
Staff time
Volunteer
time
Printing
Roles/
Responsibilities
ICGSC Director
& Executive
Committee
ICGSC Director
& Parent
Coalition
Target Dates &
Time frame
January 2014December
2016
June 2014
c) Maintain Membership profile and MOU’s for
all ICGSC board members
Staff time
Volunteer
time
ICGSC Director
2016
d) Continue Parent Financial Supports to address
barriers as identified
Staff time
Funding
source
Staff time
Funding
source
ICGSC Director
& Executive
Committee
ICGSC Director
& Executive
Committee
2016
2016
e) Provide supports to address barriers for parent
participation.
Strategy 2. Educate Ionia County Communities about Early Childhood Investment
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Progress
Measures
Principles of
Collaboration
Survey results
Over 20% parent
participation on
ICGSC
Parent member
on each
committee
Annual
completion &
Membership
numbers
MSUE results:
participation
benefits
Percentage of
budget at 50%
Parent Support
Percentage of
parent
Participation
MSUE results:
Authentic Voice
Status Review
Action Steps
Resource
Needs
Staff time
Printing
Funding
source
Roles/
Responsibilities
ICGSC Director
& Executive
Committee
Target Dates &
Time frame
2016
b) Maintain Website supports to promote
early childhood.
Staff time
Volunteer
time
Funding
source
ICGSC Director
& Executive
Committee
Ionia ISD Tech
2016
c) Create early childhood investment kits for
Ionia County distribution.
Staff time
Printing
Funding
source
ICGSC Director
& Executive
Committee
2016
a) Conduct media campaigns that include
billboards, radio, and newspaper
activities.
Progress
Measures
Number of
increased contacts
& hits as a result
as reported in the
quarterly reports
MSUE results:
Parents Needs
Met
Number of unique
visits as reported
in the quarterly
reports
MSUE results:
Improved Early
Childhood
Systems & Parents
Needs Met
Tools distributed
in conjunction
with number of
hits on website &
new contracts
added per
Quarterly reports
MSUE results:
Improved Early
Childhood
Systems
Status Review
Strategy 3. Create blended funding opportunities in Early Childhood system in Ionia County.
Action Steps
Resource
Needs
Roles/
Responsibilities
20
Target Dates &
Time frame
Progress Measures
Status Review
a) Partner with the ICSAI plan implementation
Staff time
Volunteer
time
ICGSC Director
2016
b) Parent Participation on the 211 Advisory
Board.
Staff time
Funding
source
ICGSC Director
2016
c) Parent Participation on the IoHP Advisory
Staff time
Training
Funding
source
ICGSC Director
d) Maintain and Support Montcalm and Ionia
Shared Committee Activities
Staff time
Volunteer
time
Printing
Training
Funding
source
Executive
Committee
ICGSC Director
f)
Create ICGSC board member shared funding
projects
Staff time
Funding
source
Executive
Committee
ICGSC Director
21
Number of joint
projects that are
created
Number of support
opportunities from
parent
participation
created
MSUE Evaluation
Results: Parents
Needs Are Met
January 2014Parent attendance
December
at meetings
2016
Meeting minutes
MSUE Evaluation
results: More
Responsive
Community
Context
January 2014Number of shared
December
MI activities
2016
implemented:
MSUE Evaluation
results: More
Responsive
Community
Context
January 2014Number of ICGSC
December 2016 shared funding
opportunities
created
MSUE Evaluation
results: Improved
Early Childhood
System
Strategy 4. Maintain a coordinated early childhood advocacy message in Ionia County.
Action Steps
Resource
Needs
Staff time
Volunteer
time
Printing
Training
Roles/
Responsibilities
Parent Coalition
ICGSC Director
Target Dates &
Time frame
2016
b) Implement Social Media new activities
Staff time
Volunteer
time
Training
Executive
Committee
ICGSC Director
2015
c) Create and distribute new materials
developed by parents for parents
Staff time
Volunteer
time
Printing
Training
Executive
Committee
ICGSC Director
Parent Coalition
2016
d) Encourage ICGSC logo and link on ICGSC
board members web sites
Staff time
2014
e) Produce annual Status of Young Child
Report
Staff time
Volunteer
time
Printing
Executive
Committee
ICGSC Director
Executive
Committee
ICGSC Director
Parent Coalition
a) Continue legislative advocacy efforts at
local and state level
22
2016
Progress
Status Review
Measures
Elected official
feedback to
parents
Elected official
participation in
ICGSC activities
Number of Social
media events
Number of new
contacts increased
Number of
materials created
Parent feedback
survey
MSUE Evaluation
results: More
Responsive
Community
Context
Number of access
avenues to the
ICGSC web
Report created
and utilized in
planning
MSUE Evaluation
results: More
f)
Promote Sandbox Party Activities
Staff time
Volunteer
time
Printing
Parent Coalition
Parent Liaisons
2016
Responsive
Community
Context
Number of Sand
Box party
members in Ionia
County
Goal 2. Improved wellness for children prenatally through age eight.
Office of Great Start Outcome: Children born healthy.
Strategy 1: Develop wellness supports for birth to eight families in Ionia County.
Action Steps
Resource
Needs
Staff time
Volunteer
time
Printing
Roles/
Responsibilities
Early Education
and Child Care
Committee
Target Dates &
Time frame
2016
b) Initiate Physical Health events for
kids/families
Staff time
Volunteer
time
Printing
Funding
source
Wellness
Committee
2016
c) Prenatal Smoking cessation promotion
tool distributed
Staff time
Volunteer
time
Printing
Wellness
Committee
2015
a) Promote active living and healthy eating
though education, policy and environment
changes with child care providers
23
Progress
Measures
Number of child
care providers
participating
Number of
children impacted
per quarterly
report
Number of
participants :
children impacted
per quarterly
report
% of WIC children
reporting obesity
or at risk
Number of
requests for tool
Number of
participants
Status Review
Strategy 2. Improve wellness supports access for birth to eight families.
Action Steps
Resource
Needs
Staff time
Volunteer
time
Printing
Funding
source
Roles/
Responsibilities
ICGSC Director
Parent Liaisons
Parent Coalition
Wellness
Committee
Target Dates &
Time frame
2016
b) Distribute pediatric dentistry materials in
Ionia County
Staff time
Volunteer
time
Printing
Funding
source
Parent Coalition
Wellness
Committee
2016
c) Community Awareness campaign
regarding Affordable Care Act
Staff time
Printing
Training
Wellness
Committee
Parent Coalition
2014
d) Continue implementation of dental health
campaign
Staff time
Volunteer
time
Printing
Funding
source
Wellness
Committee
2016
e) Update and maintain Social/Emotional
Resources Information.
Staff time
Volunteer
time
Printing
Wellness
Committee
2015
a) Develop partnerships with local dental
and physical health providers
24
Progress
Measures
Number of new
partnerships
developed
% of women with
inadequate
prenatal care per
Kids Count
Number of free
materials
provided
Number of
children served
per quarterly
report
Parent survey
results
Number of no
insurance reports
reduced
Number of free
materials
provided
Number of
families impacted
per quarterly
report
Number of
resources
developed &
distributed
Status Review
f)
Build farmers market and food pantry
connections.
Staff time
Volunteer
time
Printing
Wellness
Committee
2015
Number of
farmers markets
and food pantry
partnerships
Strategy 3. Build partnerships to create family support opportunities.
Action Steps
a) Support bullying prevention activities for
birth to five families.
b) Create Nutrition Night activities in
partnership with ICGSC board members
c) Support partnerships to provide
awareness of healthy eating education
d) Early Childhood Celebration in partnership
with Head Start
e) Increase access to birth to five services
through the implementation of the
Resource
Needs
Staff time
Volunteer
time
Printing
Training
Funding
source
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
Roles/
Responsibilities
Parent Coalition
Target Dates &
Time frame
2014
Progress
Measures
Number of
partnerships
developed
Number of
children impacted
Wellness
Committee
2014
Number of
participants
Number of
partners
supporting
Wellness
Committee
2016
Number of
supports
implemented
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
Family Support
Committee
2014
Number of
children impacted
Wellness
Committee
Number of
children
25
Status Review
Connections Program.
f)
Coordinate an annual Parenting
Awareness Activity.
g) Advocate for social emotional health
component in all Ionia County parenting
classes.
h) Increase the number of trainings on social
emotional interventions that include
parents & Child care providers.
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
Training
Funding
source
Staff time
Volunteer
time
Funding
source
ICGSC Director
Parent Liaisons
2016
registered
Wellness
Committee
Parent Coalition
2016
Number of
children impacted
Parent Coalition
Wellness
Committee
2016
Number of
parenting classes
participating
Number of
children impacted
Wellness
Committee
Early Education
& Child Care
Committee
2016
Number of
participants
Survey results
GOAL 3: Children in Ionia County are prepared to succeed in school.
Office of Great Start Outcome: Children ready to succeed in school at time of school
entry and prepared to succeed in fourth grade and beyond by reading proficiently by
the end of third grade.
Strategy 1: Create affordable opportunities for families to support their needs.
Action Steps
a) Continue to provide Welcome Home Baby
Resource
Needs
Staff time
Roles/
Responsibilities
Early Education
26
Target Dates &
Time frame
January 2014-
Progress
Measures
Number of
Status Review
packets in community
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
and Child Care
Committee
Parent Liaisons
ICGSC Director
December
2016
Early Education
and Child Care
Committee
Parent Liaisons
ICGSC Director
2016
c)
Increase access to and promote learning
opportunities for families with young
children
(I.e. playgroups, topic specific support groups
etc.)
Staff time
Funding
source
Early Education
and Child Care
Committee
2015
d) Promote and support literacy in the home
through (ie. Dolly Parton Imagination
Library, Ready Kits, Literacy Council,
donation programs )
Staff time
Volunteer
time
Printing
Early Education
and Child Care
Committee
Parent Coalition
2016
e)
Staff time
Volunteer
time
Printing
Training
Funding
source
Early Education
and Child Care
Committee
Parent Coalition
2016
b)
Coordinate Preschool Partnership
activities
Explore partnerships with early childhood
providers to assure children that need
special education services have access to
preschool programming.
27
partners
distributing
MSUE Evaluation
results: Parents
Needs are Met
Number of
children served in
free preschool
opportunities
MSUE Evaluation
results:
Relational
Networks
Number of
children served in
opportunities
MSUE Evaluation
results: Improved
Early Childhood
System
Number of
children impacted
DPIL Annual
survey
MSUE Evaluation
results: Parents
Needs are Met
Number of
children served
MSUE Evaluation
results: Improved
Early Childhood
System
Strategy 2. Promote affordable, quality preschool experiences in Ionia County
Action Steps
Resource
Needs
Staff time
Volunteer
time
Printing
Training
Funding
source
Staff time
Volunteer
time
Printing
Roles/
Responsibilities
Early Education
and Child Care
Committee
ICGSC Director
Target Dates &
Time frame
2014
Progress
Measures
Number of
partners involved
Number of tools
created
Early Education
and Child Care
Committee
Parent Coalition
2016
c) Promote and expand joint recruitment
opportunities and community partners (
i.e. private preschool free/low cost
opportunities)
Staff time
Volunteer
time
Printing
Early Education
and Child Care
Committee
Executive
Committee
2016
d) Continue Starfish Preschool Scholarship
Staff time
Funding
source
Staff time
Printing
Training
Funding
source
ICGSC Director
Executive
Committee
Early Education
and Child Care
Committee
Executive
Committee
2016
2016
Number of
contacts increased
MSUE Evaluation
results:
Responsive
Community
Joint recruitment
application
numbers
MSUE Evaluation
results:
Responsive
Community
Number of
scholarships
provided
Number of 3 & 4
year olds in
preschool
MSUE Evaluation
results: Improve
Early Childhood
System
a) Create tools to support transitions
between preschool and kindergarten
programming.
b) Continue campaign/messaging to educate
parents on the importance and benefits of
attending preschool.
e) Increase availability and access for 3 and 4
year olds to attend quality preschool
programs
28
Status Review
Strategy 3. Build partnerships to promote educational opportunities for caregivers
Action Steps
Resource
Needs
Staff time
Volunteer
time
Printing
Roles/
Responsibilities
Early Education
and Child Care
Committee
ICGSC Director
Target Dates &
Time frame
2016
Progress
Measures
Number of
partners
Number of
participants
b) Promote ICGSC web site calendar for early
childhood training & activity information.
Staff time
2016
Number of
partners
c) Partner with a Regional Resource Center
to promote local, quality training
opportunities and supports.
d) Establish the 0-3 Community of Practice
Staff time
Early Education
and Child Care
Committee
ICGSC Director
Early Education
and Child Care
Committee
Early Education
and Child Care
Committee
2016
Early Education
and Child Care
Committee
Number of
supports provided
a) Annual Professional Development
schedule that provides free or low cost
local trainings for parents and
providers.
Staff time
Printing
Status Review
Number of
participants
MSUE Evaluation
results: Strong
Relational
Network
Goal 4: Families support and guide the learning of birth to eight children in Ionia
County.
Office of Great Start Outcome: Children healthy, thriving, and developmentally on
track from birth to grade three.
Strategy 1: Build parent supports into the Ionia County Early Childhood System.
Action Steps
a) Publish Family Fun Guide
Resource
Needs
Staff time
Volunteer
time
Roles/
Responsibilities
Family Support
Committee
29
Target Dates &
Time frame
2016
Progress
Measures
Number of
families impacted
Status Review
b)
Promote web site to support parent’s
access to local early childhood activities.
c) Promote community garden opportunities.
d) Secure and maintain funding for resource
and referral service (211) in Ionia County.
e) Maintain parenting class opportunities.
f)
Coordinate diaper drive activities.
g) Create tool to identify agencies that
Printing
Funding
source
Staff time
Volunteer
time
Funding
source
Staff time
Volunteer
time
Printing
Training
Funding
source
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Family Support
Committee
ICGSC Director
2016
Add counter
option: Number of
unique visitors
Family Support
Committee
Wellness
Committee
2016
Number of
partnerships
developed
Family Support
2016
211 funding
obtained
MSUE Evaluation
results: Parents
Needs are Met
Family Support
2016
Number of
parenting class
opportunities
Family Support
2016
Number of diaper
supports
Family Support
2015
Number of
30
provide birth to eight basic needs
supports.
Volunteer
time
Printing
Funding
source
partnerships
developed to
create tool
Strategy 2: Strengthen collaboration between referral sources.
Action Steps
a) Host networking activities between service
providers.
b) Establish connection to Ministerial
association in Ionia County.
c)
Conduct Mandated Reporter training
d) Partner with the Continuum of Care:
Housing Connect Event
Resource
Needs
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Printing
Roles/
Responsibilities
Family Support
Committee
Target Dates &
Time frame
2015
ICGSC Director
Parent Liaisons
2014
Staff time
Volunteer
time
Printing
Funding
source
Staff time
Volunteer
time
Printing
Family Support
Committee
2015
Number of
participants
Parent Liaisons
Family Support
Committee
2014
Number of
families impacted
31
Progress
Measures
Number of
participants
MSUE Evaluation
results: Strong
Relational
Network
Number of
supports as a
result
MSUE Evaluation
results: Strong
Relational
Network
Status Review
Financing and Fund Development
The Ionia County Great Start Collaborative has identified six goals that need to be
addressed in order to achieve our vision that “Children in Ionia County are healthy,
eager, and prepared to succeed in school and life.” In order for the ICGSC to accurately
address the issues through the identified goals, strategies, and action agenda we will
need following resources:
* Human Capital
* Local Funding Sources
* In Kind supports
* Assessment and Data Systems
Human Capital:
The ICGSC Executive Committee has established the following committees to assist
them in addressing each of the goal areas in the action agenda:
* Early Education & Child Care Committee
* Family Support Committee
* Parent Leadership Committee
* Family Wellness Committee
* Executive Committee
The committees are chaired by individual ICGSC board members from different sectors in
Ionia County and include at least one parent representative. Each of these committees
meet a minimum of six times per calendar year to address the strategies outlined in the
action agenda to ensure measurable results.
Financing and Fund Development:
Committees will provide a report on work and progress at each ICGSC Board Meeting.
Executive Committee membership is comprised of members who have the authority to
commit funds, staff and other resources on behalf of his/her organization. Partnerships will
be maintained with existing early childhood, agencies and business organizations.
Additional partnerships will be made through the work of all the committees with other key
stakeholders in the community who support the vision and mission of the Ionia County
Great Start Collaborative. Annually, each participating member of the ICGSC Board will
have a signed Memorandum of Understanding document on file with the ICGSC Director.
Local Funding Sources:
Financial support will be needed to adequately address the action agenda and goals.
The Ionia County Great Start Collaborative, ICGSC Director, ICGSC Chair, Parent Support
Team, and the Executive Committee, will secure and maintain local funding by developing
relationships with local community foundations, businesses, and key stakeholders in the
county to solicit financial investment in early childhood systems and supports. The ICGSC
Board members will also explore grant opportunities available for early childhood related
initiatives. ICGSC board members will commit financial supports as available to support the
work of the action agenda.
32
Financing and Fund Development
The ICGSC will continue to solicit financial investment in early childhood systems,
services, and supports from all early childhood partners as well as the business community
at large. The ICGSC Board will continue to advocate for the completion of the Action
Agenda through increased revenue sharing, partnerships in training and service delivery
efforts, as well as in-kind supports.
Assessment and Data Systems:
The Ionia County Great Start Collaborative recognizes that a system is necessary to
support information sharing and evaluation of the strategies outlined in the Action
Agenda. The Executive Committee works with all collaborative member agencies and
organizations to determine the current capabilities for data sharing to guarantee up to date
and accurate data for the ongoing collaborative work of the ICGSC. Information is stored
on the ICGSC website to support assessment and open data sharing.
33
Appendices
Appendix A: Ionia County Great Start Collaborative Strategic Planning Process
Appendix B: Status of Young Children Report
Appendix C: Collaborative Strategic Planning Outline
Appendix D: EightCAP Report
Appendix E: Head Start Comprehensive Community Needs Assessment
Appendix F: Ionia County Community Mental Health Consumers Served Report
Appendix G: Ionia County Health Department Brief
Appendix H: Ionia County Behavioral Risk Factor Survey
Appendix I: Great Start Initiative Executive Summary
Appendix J: About the Great Start Evaluation
Appendix K: Executive Summary Reflection Questions
Appendix L: Ionia County Great Start Collaborative Strategic Planning Presentation
Appendix M: Ionia County Kids Count 2012 Data
Appendix N: Kindergarten Roundup 2012 Report
Appendix O: Ionia County Kids Count 2013 Data
Appendix P: Sparrow Ionia Hospital Community Needs Health Assessment
Appendix Q: Dolly Parton Imagine Library Survey Results Report 2012
Appendix R: Ionia County Department of Human Services Fact Sheet
34
Ionia County Great Start Collaborative 2012-13 Strategic Planning Process
During the Fall of 2012 the Strategic Planning update process began for the ICGSC board
members and the Ionia County community. The Ionia County Great Start Collaborative
collected and reviewed data specific to our community in the area of Community Conditions,
Early Care and Education, Family Support, Physical Health, and Social Emotional Health.
The data collection included many sources of local and state data sources. During the year
ICGSC board members participate in Data Sharing activities at each board meeting. This data
along with other resources was reviewed during the Strategic Planning process. At board
meetings throughout the fiscal year strategic planning activities were completed to assist with
creating an effective updated plan. Data examples that were used in the strategic planning
process to gain the perspective of on our current community conditions and priorities for the
next three years were the complied surveys from Kindergarten Roundup in all five school
districts, a Health Status Assessment from the Sparrow Ionia Hospital and 20 Community Café
Conversations (with over 200 birth to five parents participating).
Community Café Conversations’ were hosted at all of the geographic areas with in Ionia
County at existing activities with in ICGSC partner building such as the elementary schools
and the Ionia Intermediate School District. Information was made accessible in a variety of
formats for parent input to be collected. The Café Conversation surveys were posted on
Facebook, on line on the ICGSC website, and sent out via email to our list serves. 200 Ionia
County birth to five parents participated in our Community Café Conversations for the
strategic planning process.
New partnerships were formed during this process. As a result, local libraries hosted events for
parents to participate in our strategic planning process. After the Parent Liaisons facilitated
20 community conversations with in Ionia County in the 2013 early winter; ICGSC board
members designated time in their regularly scheduled board meetings such as “Spend a Buck”
and “Keep; Modify; or Delete” activities in order to help prioritize the valuable information
that was obtained from the community. In the spring of 2013 the Executive Committee
determined that a facilitator was needed to assist with two specific ICGSC board meeting
activities. The facilitator was contracted to assist with strategic data analysis. The data
analysis compiled information was utilized in two board meeting conversations to allow for
meaningful, honest conversations about the direction of early childhood services and supports
in Ionia County. See included power point from the ICGSC board meeting discussion.
Goals, objectives (strategies), and activities were identified at the board level. Once this
occurred the existing ICGSC committee’s took the information back to their committee
meetings during the months of July and August in the summer of 2013 to finish the identified
strategies and activities needed to accomplish the identified goals for the ICGSC Strategic
Plan.
Appendix A
35
ICGSC Board Meeting results 2013
36
Community Café Conversation Compiled Results
37
Dear Community Member,
We know that the first five years of a child’s life lay the foundation for language,
social behavior, problem solving, ability, and other important brain developments.
This time is an opportunity to build our young children's brains. As a community
there are still so many things that we can do to support parents in their efforts to
raise healthy children. Research tells us that by age six, ninety percent of a child's
brain will be built. Supporting parents matters because parents are their child's first
and best teacher.
Parents and community leaders in Ionia County who understand the vital
importance of investing in young children continue to work together to implement
the next strategic plan of the Ionia County Great Start Collaborative (ICGSC). The
ICGSC works to build an Early Childhood system that families can navigate to get
their needs met. This system building initiative hopes to make changes to support
families and children during the most impactful time of a child’s life.
The ICGSC has had many successes over the last 3 years. Increasing preschool
opportunities, local access to a pediatrician and OBGYN, and partnering with local
businesses to create family friendly community activities are just a few things that
the ICGSC has supported.
We understand wise investments need to be made now in order to ensure that our
children will be successful adults. The Ionia County Early Childhood Action
Agenda focuses our attention and helps us develop a blue print to improve the
outcomes for our 4,922 children ages birth to five or for the 785 new births during
2011.
This 2012 report is the fourth report that the ICGSC has prepared to present information about our community and our young children. The data presented comes
from a variety of sources using the latest data available. These references are
included in the back of this report. We want to know your perspective on how we
can support you and your family in getting your child off to a great start. Please
call 616-522-1412 or check our website at GreatStartIoniaCounty.org to become
involved in this effort. We invite you to join us in our efforts!
Sincerely,
Ionia County Great Start Collaborative
Appendix B
38
The Status of Young Children in Ionia County
THE ISSUES:
 20.7% of children ages birth to eighteen live in poverty.
 47.6% of our students receive free or reduced school lunch assistance.
 33% of Ionia County mothers who gave birth did not receive appropriate health care. This is an
11% increase from last year’s reporting. 4.4% of mothers report they had late or no prenatal care;
up from 2.8%.
 Ionia County has seen a decrease in our teen parent population for the first time in many years. The
percentage of Repeat teen births is 16.4%, down 4%.
 45.2% of Ionia County births are paid for by Medicaid.
 54.4%% of children ages 1-4 are participating in WIC. 7% of children ages 2-5 that are enrolled
in Women’s, Infant and Children (WIC) supplements in Ionia County were overweight or at risk of
becoming overweight. This number is down from 2011’s 23%.
 Ionia County continues to see a dramatic increase in the number of children birth to five that were
substantiated for child abuse and neglect. From 18.2% in 2009 to 25.6% in 2010. The state
average is 13.8%.
Entire Report Data Sources: Community Level Information on Kids (CLICKS), Michigan Kids Count
Ionia County Great Start Collaborative and Great Start Parent Coalition are the focal point
for local early childhood efforts. For more information about early childhood in Ionia County or to
provide feedback regarding this data, please go to:
www.GreatStartIoniaCounty.org
39
Physical Health
Strengths
Good doctors
211
Direct relation to academic success
Problems
Services aren’t available for kids with Medicaid
transportation issues
cost of activities
technology replacing activity
Threats
state budget issues
Affordable Care Act only lasts 2 years
Lack of programming
Opportunities
Affordable Care Act
More education for healthy lifestyles
resources on available doctor options
Social Emotional Health
Strengths
MHP’s for foster youth – opp for mental health services
Dolly Parton Imagination Library
Drug Court
Growing/Stable prevention programs at DHS
Extension with voluntary Foster Care for older youth
Opportunities
Collaboratives in community
researching possible alternative ed program: JAG
MY01
Problems
Increase in confirmed youth afflicted with abuse and/
or neglect
decrease in counselors in schools, also nurses in
schools
Homelessness/unemployment
Threats
DHS funding cut for counseling, etc
meth production in area
funding cuts statewide
Family Support
Strengths
parent coalition gets info to parents
hospitals more connected & able to share info/records
schools more connected thru electronic info
single application for childcare areas
Problems
Families not aware of what is available
the “run around” of application process
families are smaller & extended family does not live
near each other
head start waiting list
Opportunities
Head start
DPIL
Facebook pages for GSC, etc
increase in available parenting classes
Threats
lack of financial support for programs
decrease in funding for DHS, Mental health, any
service agency
social stigma
Childcare & Early Education
Strengths
more qualified providers-new star rating
collaboration between providers
gives kids structure, purpose, direction, excitement
Opportunities
earlier education, better for kids socialization for single or
younger kids
earlier observation to potentially identify problems,
delays, etc
educating families on the importance of higher (more
qualified/trained) childcare
40
Problems
potential loss of qualified providers-New star rating
teachers
parental fear, trust, confidence
provider cost
lack of resource knowledge and/or cost for resources
parental lack of knowledge/confidence in being their
child’s first teacher
funding for preschool
physical facility availability
Threats
Funding
cost, availability, time for provider training and
continued certification
Appendix C
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
Appendix D
2011 – 2012
Comprehensive Community Needs Assessment
EightCAP, Inc. 0 - 5 Head Start Programs
Clinton (EHS), Gratiot, Isabella, Montcalm and Ionia
Counties
Michigan
Appendix E
I.
Geographic Description of the Area
EightCAP, Inc. is a community action agency designated to serve the counties of Gratiot, Ionia, Isabella, and
Montcalm in the central portion of the lower peninsula of Michigan. For the purposes of Early Head Start
only, Clinton County, bordering Gratiot County, is also included in the designation. This service delivery area
covers about 3,000 square miles of predominantly rural countryside. Sixty-seven percent of the residents live
outside of incorporated cities or villages. There are only ten incorporated cities in the geographic area with
populations of 5,000 or more. Population growth has been slightly decreasing in Gratiot County, while
increasing from 2.5% to 7.7% in the other four counties.
The cities of St. Johns (Clinton), Ithaca (Gratiot), Ionia (Ionia), Mount Pleasant (Isabella), and Stanton
(Montcalm) serve as county seats of their respective counties. Isabella County encompasses the SaginawChippewa Indian Tribe, which oversees the operation of the Soaring Eagle Casino & Resort, as well as
comprehensive educational, health, and social welfare systems. Mount Pleasant is also the site of Central
Michigan University, with a population of approximately 16,000 on-campus students and 10,000 off-campus
students. Alma College offers liberal arts programming to over 1,500 state, national, and international youth.
A satellite campus of Davenport College, also located within the area, serves about 350 students. Almost
4,000 students attend Mid-Michigan and Montcalm Community Colleges. Vocational technical schools enroll
over 100 trainees annually. It should be noted that college students are considered transient in the population
count due to the nature of their residence. St. Johns and surrounding cities and villages serve as suburbs for
employment
One interstate and two U.S. expressways travel through the area.
Six major Michigan thoroughfares pass through as well. Numerous
county roads, paved and gravel, allow for travel within the area.
Each of the four counties has public transportation services
available. However, the only cities with access to this
transportation are Alma in Gratiot County, Mount Pleasant and out
county on a will-call basis in Isabella County, Greenville, Sidney
and Stanton in Montcalm County, and Belding and the city of Ionia
in Ionia County.
The western borders of Montcalm and Ionia County border Kent
County, with a considerable population base and labor market due
to the city of Grand Rapids. Lansing, the state capital of Michigan,
is within twenty miles of southeastern Ionia County. These two
large cities attract business, industry, and job seekers from our
service area. The northern borders of Isabella and Montcalm
counties encompass the recreational aspects of Michigan--lakes,
forests, rivers, and wilderness. This area is often called "the
gateway to the North."
This information defines the area as rural; the map identifies counties of service.
Appendix E
2011 – 2012 Updated Community Needs Assessment
Gratiot County
2009 Population
Percent change 2000-2008
Minority population (2000 Census)
Total child population
Ages 0-4
Ages 5-9
Total Live Births (2007)
41,948
Children below the poverty level
Children receiving subsidized child care
Children receiving FIP
Children in Food Assistance Program
Children insured by Medicaid/MIChild
Percent of children receiving free/reduced lunch
Children in Special Education (2006-2007 school year)
Children receiving SSI
Infants born with birth defects
0.1 %
8.5%
9,023
2,411
2,406
495
↓
↔
↓
↑
↑
↓
21.7%
6.5%
3.5%
26.7%
42.2%
41.6%
18.0%
15.1%
5.0%
↑
↓
↓
5.4%
13.6%
12,373
3,525
3,387
726
↑
↑
↑
↑
↑
↓
↑
↓
↓
Isabella County
2009 Population
Ages 0-4
Ages 5-9
67,176
Children receiving FIP<
21.7% ↑
5.9% ↓
1.9% ↓
19.7%
36.9%
33.2%
18.8%
16.2%
5.8% ↓
↑
Appendix E
2011 – 2012 Updated Community Needs Assessment (continued)
Montcalm County
2009 Population
Ages 0-4
Ages 5-9
62,733
2.8 %
6%
15,967
4,090
4,046
842
↑
↔
↑
↑
↓
↓
25.7%
3.5%
2.5%
26.1%
44.5%
↑
↓
↓
Children in Special Education
50.6%
17.0%
18.5%
5.6%
↓
3.8%
6%
15,361
4,118
4,155
808
↑
↔
↓
↓
↓
↓
↑
Ionia County
2009 Population
Ages 0-4
Ages 5-9
62,574
16.6%
3.8%
2.9%
17.4%
Children in Special Education
35.8%
41.4%
18.9%
10.5%
6.0%
↑
↓
↓
Appendix E
2011 – 2012 Updated Community Needs Assessment (continued)
Clinton County
2009 Population
Ages 0-4
Ages 5-9
69,893
7.7 %
3.2%
17,095
4,200
4,449↑
784
↑
↔
↓
↑
7.7%
2.8%
1.1%
11%
21.3%
20.2%
13.4%
5.8%
7.1%
↑
↓
↓
↓
↑
↓
↓
2. General Description of Service Area
The service area, on average, is 92.5% white and, of the minority population reporting, 2.6 %
were Afro-American, 2.86% Hispanic or Latino, and 2.04 % other races. Although the area
population has increased in four of the five counties between 2000 and 2008, most recent
projected population growth rates in the area decreased, with the total population down an
average of 1.5%. In particular, Montcalm County showed the highest decline at 2% while
Gratiot and Isabella counties maintained in the same time period. 14,144 children, 0-4, resided
in mid-Michigan in 2007; 13,994 elementary school age youngsters were recorded in 2007;
14,187 middle schoolers were noted in 2007; and 20,902 high school youth were reported in
2007. In most cases, the number of school age youngsters living in the four-county area has
declined.
The primary language of EightCAP’s designated service area is English. Spanish-speaking
families without English as a second language are less than 1%. Translators are needed for
about 2% of Head Start and Early Head Start families. School districts frequently call the Head
Start program for assistance in presenting kindergarten or other information to non English
parents; likewise, parents request translation services as they deal with community agencies and
schools. A few families participating in the college/university partnership centers may require
translation for other foreign languages, as well.
Trends in adolescent well being are inconsistent, with the births to teen rate exceeding the State
rate in three out of four counties; the numbers of deaths by accident, homicide, or suicide
significantly decreased in three counties, while worsening in the fourth; and the percentage of
Appendix E
high school drop-outs split with two counties improving graduation rates and two counties’ rates
plunging. Activities available to youth include 4-H; Girl Scouts/Boy Scouts; county summer
recreation program; after-school events; organized weekend youth centers; America’s Promise
activities, and regularly scheduled church youth groups.
Between 2010 and 2050, the United States is projected to experience rapid growth in its older
population. In 2050, the number of Americans aged 65 and older is projected to be 88.5 million,
more than double its projected population of 40.2 million in 2010. The baby boomers are largely
responsible for this increase in the older population, as they will begin crossing into this category
in 2011. The aging of the population will have wide-ranging implications for the country. As
the United States ages over the next several decades, its older population will become more
racially and ethnically diverse. Projecting the size and structure, in terms of age, sex, race, and
Hispanic origin, of the older population is important to public and private interests, both socially
and economically. The projected growth of the older population in the United States will present
challenges to policy makers and programs, such as Social Security and Medicare. It will also
affect families, businesses, and health care providers.
Likewise, Michiganders are getting older and living longer. The over 65 population represents
about 12% of the state population, with a recorded increase of 12.5% from 1990 to 2000 in
EightCAP’s general service area; Clinton County reflected a 15.5% increase from 1990 to 2000.
About 1 in every 8 Michigan residents is currently part of the elder population, while a 6%
decrease of the under 17 population occurred in the same period.
Homelessness can be found in all communities—rural or urban. It is not restrictive to age,
gender, ethnicity, economic status, disability or familiar status. It can happen to anyone, anytime,
anyplace. Although rural homelessness is not always visible, it does indeed exist in many forms,
including multiple families sharing one housing unit; families moving from one relatives’ home
to another; and families using temporary housing such tents, campers or other minimal
structures.
The mid-Michigan counties of Clinton, Gratiot, Ionia, Isabella and Montcalm are not immune to
homelessness. People living without stable and safe housing are a concern for area leaders,
human service providers, and the general community. A plan of action is warranted to ensure
that local resident’s basic needs of housing are met.
The demographics of these rural counties pose barriers for the prevention or elimination of
homelessness, including
• The insufficiency of jobs and lack of a living wage;
• limited economic development;
• high rates of poverty;
• above average rates of domestic violence;
• limited public transportation;
• limited or no access to transitional housing or shelters; and
• the overall lack of affordable and safe housing.
Grandparents as parenting adults are on the rise, estimated by the Department of Human Services
to be about 10% of the 0-5 population. This may be due to births to teenage moms, births to
parents with substance abuse issues, incarceration of parents, or abandonment. Grandparents
raising grandchildren are increasingly frustrated by the lack of resources available to support
Appendix E
their surrogate responsibilities, both financial and human.
The incidence of foster care placement has also raised, at the same time as the unfortunate
decline in available foster care placements. The new statewide focus of implementing
concurrent planning for children in the Child Welfare system is being piloted in at least two
counties served by EightCAP, Inc.
The understanding of general population trend indicators is essential for human resource
development, educational planning, as well as future policy making.
3.
Economic Features
Michigan was the only state where poverty rose and incomes fell last year, according to the U.S.
Census Bureau. The statistics illustrate the uniqueness of Michigan's economic swoon, and the
extent to which the auto industry's downward plunge has caused a ripple effect across the state.
County poverty rates were reported in 2008 as Cl/8.0%;Gr/15.2; Io/14%; Is/29.4%; and
Mo/15.5%.
The 2007 median income in Michigan was $47,950, down 1.2 percent or $596 from the 2006
median of $48,546 – the state's nationwide ranking slid from 24th to 27th. Michigan’s 2008
median income was $47,950, This revealed a drop of 3.6% in inflation adjusted dollars.
The SAIPE/US Census Bureau estimates median incomes of the counties served by EightCAP to
be:
1. Clinton County
$67,000
2. Gratiot County
$52,700
3. Ionia County
$63,100
4. Isabella County
$56,700
5. Montcalm County
$52,700
meaning half of all households in mid-Michigan had incomes higher than those displayed above
and half had incomes lower than this amount.
Michigan has also displayed an increased rate of "extreme poverty" -- a yearly income of less
than half the poverty threshold, or $10,325 for a family of four. People with incomes that low
may be living in unsafe conditions; are probably are not getting enough healthy food to eat; may
be living in short-term shelters; and are likely skipping dosages of medication to make ends
meet.
Many people are struggling harder and harder just to get by, and more vulnerable people are
turning to public social support for help. In addition to the 1,376,658 people who are poor in
Michigan, 1,649,567 people, an additional 16.8%, are at risk of falling into poverty. These
individuals, often called low income, have family incomes that fall between the official poverty
line and twice the poverty line. This leaves them dangerously close to the edge, where just one
event, such as an illness or job loss, can push them into poverty.
The Census Bureau reports 11 percent of Michigan residents had no health insurance coverage in
2007 -- up from 10.4 percent in 2006 and 9.1 percent at the beginning of the decade. But that
Appendix E
was one category in which Michigan fared better than most other states. The national average of
uninsured citizens was 15.5 percent, and Michigan ranked 11th best nationally in providing
health coverage.
More than 18 % of Michigan residents get some type of assistance through the Michigan
Department of Human Services. Although general cash assistance is declining, programs that
provide food and emergency help with energy and medical bills are growing steadily. The Food
Assistance Program is up 136% since December 2000. Local food pantries and agencies who
offer emergency cash assistance have never seen the volume of cries for help as they are seeing
in 2010.
Per Capita Income - 2008
Clinton
Isabella
$32,760
$25,988
Gratiot
Montcalm
$23,398
$21,786
Ionia $24,141
Since 1969, the relative per capita income standings of Gratiot, Isabella, and Ionia counties has
worsened, while the Montcalm County per capita has seriously worsened by the loss of its
manufacturing base.
American families today are increasingly feeling the pinch of higher energy prices, housing market
uncertainty, and growing health care costs. Historically, typical families could expect to see annual
increases in their earnings to help cope with financial challenges, improve their standard of living, or
just save for a rainy day. These expectations of economic progress are no longer being met. In an
alarming reversal of past progress, real household income for the typical family has declined over
the last several years.
Taken together, the increase in household incomes at the median was likely due to an increase in fulltime workers, more hours worked, and/or changes in family composition. Estimates suggest that
typical families now are finding it increasingly difficult to maintain real income levels. Even with
additional members seeking part or full-time work, families are still seeing little improvement in their
bottom line as median earnings continue to fall.
The federal poverty line has traditionally been used to measure whether families have incomes high
enough to enable them to meet basic needs. Yet most researchers now agree that a "poverty line"
income is not sufficient to support most working families. "Basic family budgets," individualized for
communities nationwide and for type of family (e.g., one parent/one child, two parents/two children)
offer a realistic measure of the income required to have a safe and decent, though basic, standard of
living.
The Family Budget Calculator determines the income needed for particular types of families to make
ends meet. Because costs of goods and services vary across the U.S., the calculator customizes the
budgets for many U.S. communities—over 400 in all. Users select from one of six family types, pick
a state, and then select a community to see how much that family is likely to need for housing, food,
child care, etc. The calculator also shows the percent and number of families in that state living
below the family budget level.
It is important to note that a basic family budget is indeed "basic." It comprises only the amounts a
family needs to spend to feed, shelter, and clothe it, get to work and school, and subsist in 21st
century America. Hence, it includes no savings, no restaurant meals, no funds for emergencies—not
even renters' insurance to protect against fire, flood or theft.
Appendix E
2009 Basic Family Budgets (Calculator)
(1 Parent/3 Children Rural, Michigan)
Monthly housing
Monthly food
Monthly child care
Monthly transportation
Monthly health care
Monthly other necessities
Monthly taxes
Monthly total
Annual total
Percentage of all people in state living below family budget line*
Number of all people in state living below family budget line*
$673
$562
$706
$313
$305
$333
$83
$2,975
$35,700
22.6%
409,000
(1 Parent/1 Child Rural, Michigan)
Monthly housing
Monthly food
Monthly child care
Monthly health care
Monthly taxes
Monthly total
Annual total
$514
$265
$467
$313
$218
$210
$92
$2,079
$24,948
22.6%
409,000
(2 Parents/2 Children Rural, Michigan)
Monthly housing
Monthly food
Monthly child care
Monthly health care
Monthly taxes
Monthly total
Annual total
$514
$587
$586
$420
$329
$297
$85
$2,818
$33,816
22.6%
409,000
According to thehealthybelly.com, the estimated cost of raising one child, without expectation of a college
Appendix E
education is:
Expense
Start Age
End Age
Housing
0
18
Groceries
0
18
Food
0
18
gifts
0
18
Transportation
0
18
Clothing
0
18
Healthcare
0
18
Childcare/Education
0
18
Recreation
0
18
Sports
5
18
Social
5
18
Insurance
5
18
Miscellaneous
0
18
College
18
22
Annual Cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
4398
1525
2008
330
1695
535
735
1330
330
250
450
450
1272
12796
Cost for first year (excluding college) is $15,308.00 Total cost is $269,794.00
The above cost comparison was aimed at helping middle to high-income families plan financially to raise a
child. The stark reality of these figures to a low-income or fixed-income family is devastating.
The Economically Disadvantaged
The economically disadvantaged population has risen since the last community assessment, leaving
approximately 32,000 individuals in the four-county area living in poverty. Females are 48.4% of
those in the labor force at an economic disadvantage and 70% of the welfare registrants in the twocounty area.
Appendix E
The average monthly FIP cash assistance grant, between $368 and $527 per month, is based on a
family size of three, and represents the average amount received by a family qualifying for the
TANF programs. Many families have had a portion of this grant amount offset by their wage
earnings. On average, it is locally estimated that this monthly amount must cover housing ($422);
food ($491); clothing, household items, and phone ($233); transportation ($266); health costs
($183); child care ($708); and taxes ($394). Payment rates have not increased since 1990, despite
the fact that their purchasing power has eroded by approximately 32% since 1986.
According to 2000 census estimates, 5% - 7% of the area households subsist on an annual income of
less than $6,500. As an agency that helps families meet emergency needs, this fact has borne out as
more and more families report no income or means of support. To further substantiate this need, the
Federal Head Start program has deemed homeless families as categorically eligible to participate in
the program.
Unemployment Rates
The February 2010, unemployment rates in the designated service area of EightCAP, Inc. included:
• Gratiot – 15.2% or 2,970 registered unemployed;
• Isabella – 9.7% or 3,712 registered unemployed;
• Montcalm – 19% or 4,947 registered unemployed;
• Ionia – 15.3% or 4,503 registered unemployed; and
• Clinton – 10.3% or 3,865 registered unemployed.
These figures reflect a steady increase in joblessness due to the recent downturn in the economy.
The unfortunate closing of the Total Petroleum and several supply feeder plants in Gratiot County in
recent years has seriously affected employment rates. Electrolux completely abandoned its
workforce in Montcalm County, with a total shut down of their plant. It is estimated that as many as
8,000 jobs related to Electrolux manufacturing have been lost locally. Compounding the
employment situation even further is the steady decline of American automobile production,
impacting parts suppliers situated around mid-Michigan.
The newest segment of the population living in poverty or near poverty is those affected by job loss
due to the failing economy. Persons who lived comfortably with job security and what they thought
was manageable credit debt now find themselves jobless, unemployment benefits expiring, and with
no relief in sight. The State of Michigan has devoted what resources it can to assist Michigan
Works! in retraining and job placement efforts, but the impact on mid-Michigan has been
devastating.
A competition has developed in the geographic area for skilled labor, as well as dependable, entry
level employees. New employers, such as Solar Ovanics, require skill sets not readily available
from unemployed laborers. This has required importing employees to fill jobs needing technical
proficiency; providing little or n relief to the jobless rate.
The working poor account for one-fourth of all families with children; and unfortunately
employment secured by this segment of the population is low skilled, low paying, and most often
benefit-less. Many families fare less well than when they received public assistance.
Local area jobs are concentrated in government (including casinos), services, manufacturing, and
Appendix E
retail trade. A significantly higher proportion of government and retail trade jobs are available in
Gratiot and Isabella counties than statewide or nationally. This same trend is expected to continue
for the next 5 years.
4.
Housing
Home Ownership and Burdened Households
Mid-Michigan is a rural area experiencing typical rural problems that are compounded by extreme joblessness
and very limited community resources. A lack of safe, affordable, comfortable housing is a growing concern
for low-income families as they seek employment and prepare to leave the welfare rolls. Individuals may be
forced to obtain substandard mobile homes, or expensive, unsubsidized apartment housing. Consumers may
also be forced to seek shelter with relatives, friends, or in housing in extremely isolated areas, compounding
transportation problems and social opportunities for families.
Data from the U.S. Census Bureau revealed the following breakdown of households in the EightCAP, Inc.
service delivery area for 2005:
Number of Available
Average Mortgage
Renters/Monthly
Housing Units
Payment per Month
Rental Amount
County
Gratiot
15,900
$500 to $1,500
3,252/$300-$749
Ionia
23,648
$500 to $1,500
4,196/$300-$749
Isabella
28,185
$500 to $1,500
6,160/$300-$749
Montcalm
27,285
$500 to $1,500
3,817/$300-$749
Census statistics further revealed that a significant portion of households bear a high cost burden to pay for
their housing (more than 30% of their gross income), or live in substandard housing. These burdened
households comprise 21% of the total households in Gratiot County, 21% in Ionia County, 31% in Isabella
County, and 23% in Montcalm County.
The population of Central Michigan University students residing in Isabella County contributes to the
substantially greater proportion of renters and burdened households. Also, Isabella County families already
spending a disproportionate amount of income on housing could be put at a further disadvantage by the rising
housing prices stemming from the expanded Soaring Eagle Casino and Resort. These increasing prices may
also contribute to the greater proportion of renters in Isabella County as the cost of owning a home rises out of
the reach of many families.
Household Income and Energy Statistics
The majority of homes in the four-county area are heated by natural gas, closely followed by bottled, tank, or
LP gas. Many of low-income residents live in rural areas that can only be serviced by LP gas delivery; wood
heat is also popular for rural homes. A relatively small segment of the population uses oil to heat their homes.
Electric home and water heating is an especially expensive cost to users.
In FY 2009, EightCAP, Inc. weatherized the homes of over 222 low income families in the four-county
service delivery area, and will far exceed that number in Fiscal Year 2010, due to the dramatic increase in
home weatherization funding through ARRA. Weatherization by EightCAP is designed to make homes more
energy efficient, saving families' energy dollars and providing a warmer shelter against the harsh Michigan
winters.
There is still uncertainty whether additional LIHEAP funds, appropriated by Congress and directed in
Michigan Department of Human Services and to Michigan Community Action Agencies will be available to
provide such improvements as new heating plants, roofs, and other more costly energy-saving measures.
Appendix E
EightCAP has initiated a renewed energy-saving public information campaign to alert area residents to
methods of reducing energy usage, thereby reducing utility costs. In prior years the classes have been
moderately attended; larger and more attentive numbers of attendees are learning energy conservation and
cost effectiveness in recent classes.
EightCAP also prevented utility shut-offs to approximately 4,000 families in the service delivery area and
served over an additional 8,000 persons with supportive community services. Paying utility bills for lowincome families who cannot be assisted by the Department of Human Services helps enable these families to
stay in their homes and at their jobs, and provides a safer, more stable environment for their children.
In the past three years, EightCAP, Inc. has sponsored “Walk for Warmth” efforts that have generated over
$45,000 in funding to offset utility payments of area families, the elderly and residents with a disability.
5.
Health Information
State budget cuts have drastically reduced the health services available to pregnant women and their newborn
infants. Maternal and infant programs which historically supported “at risk” prenatals and babies through
local community health departments have been abandoned. Directly corresponding is the increase of
inadequate prenatal care in the State of Michigan by 70%. Locally, inadequate prenatal care worsened by as
much as 32%. The number of infants born with a low birth weight also increased.
The number of children with completed immunizations in the State of Michigan and the EightCAP service
catchment area are increasing due to heightened public information campaigns. Immunization status remains
a concern, however, because of the high number of low-income working families who cannot arrange clinic
visits during the daytime. Evening and weekend clinics are needed to accommodate parents. A new
emphasis of both the public and private healthcare systems has heightened awareness of the complications of
chickenpox if immunizations are ignored. There appears to be a battle between public health and area
physicians over the pneumonia vaccination – although a series by age 5 is required, inconsistent application
has clouded the validity in the eyes of the medical profession.
A severe shortage of dentists who will accept Medicaid reimbursement jeopardizes the dental health of area
citizens. As few as one or two dental practitioners per county accept low-income families, either uninsured or
insured by Medicaid. The Oral Health Coalition of Montcalm County, included in this service area, received
a Community Health grant to provide a full range of dental health services to low-income children. In the
past, EightCAP, Inc. has devoted a portion of its CSBG core grant to assist in the operation of this Dental
Clinic; funding reductions required that the agency could no longer make this contribution. Through
negotiations, the Dental Clinic will serve Gratiot County Head Start youngsters on an emergency basis. It is a
goal to seek similar funding for the entire area, but State resources for community health have been greatly
reduced.
State budget cuts have eliminated many programs offered by local health and mental health departments,
including EPSDT screenings, insurance sponsored counseling, drug and alcohol treatment programs, fullyfunded maternal and infant support systems, etc. In many cases, third party payment, including Head Start,
MSRP, or Special/General Education funding, must be sought to provide necessary services to families.
Michigan will soon be taking action to balance a sagging budget; serious cuts to children’s health programs
may occur.
Another issue that affects the early childhood population is the reduction in the comprehensiveness of
physician-completed medical exams. In many instances, blood leads, hematocrits, blood pressures, and other
required screenings are not completed, negating the “red flags” of a child’s health status. Through agreements
with local health departments, clinics that provide H/H and lead level testing, fluoride varnishes, and hearing
and vision screenings are conducted at each Head Start and Early Head Start center, as well as playgroup and
Family Fun Nights.
Appendix E
While head lice continue to plague area families, the Head Start program has taken a new stance on head lice,
including the use of natural remedies and the non exclusion of children with head lice. Family support staff
are to work closely with families considered “chronic” with head lice to bring some resolution to the
infestation problem. The program is very up front with families and notifies them if a breakout of head lice
occurs. This policy was approved by Policy Council and developed in conjunction with the Medical Director
of the Mid-Michigan District Health and Central Michigan District Health Departments. Again, health
departments have been forced to eliminate projects which once addressed the head lice problem, and lice are
perceived as “pests” in the child welfare and health systems of Michigan. There is no funding available to
assist in the cleanup of families homes; Head Start has been able to loan vacuum cleaners when families are
lacking one; and supply families with natural remedies to kill lice and eggs in their homes.
Although every state entity is encouraging families to establish a medical home within their HMO (formerly
Medicaid) provider, many still utilize walk-in clinics and emergency rooms. In Michigan, payment for such
services is often withheld because ER’s or clinics are not authorized to provide treatment. Local early
childhood programs constantly reinforce the need to carefully select a family physician, and then follow the
prescribed process for medical treatment. Much education in this area is still needed.
Against a backdrop of change surrounding insurance coverage for children, the rate of uninsured children
remained the same between 2000 and 2006. Nationally, 12.5% of children lack health insurance; perhaps as
many as 20% of mid-Michigan youngsters are not insured. Higher income children experienced a statistically
significant (2 percentage points) increase in non insured, which was concentrated among children with family
incomes between 200 and 300 percent of poverty. During that same period, the number of uninsured children
with family incomes above 200% of poverty rose dramatically – 600,000 nationally. Higher income children
also experienced modest declines in health care access, and were more likely to be uninsured in 2006. It
appears that higher-income children also experienced a reduction in employer-sponsored insurance. New
Federal HHS regulations, currently being promulgated, may allow state’s greater latitude in determining
eligibility for Medicaid or SCHIP.
Most adults who are uninsured by a private provider through their work remain uninsured. As yet, no
community solutions have been reached for this issue. The Head Start program has arranged for the Mobil
Dentist to see uninsured adults in local clinics during the year, when available spots are not taken by needy
children.
Mental Health
Community mental health is publicly-funded in Michigan, but has had to reduce the availability and level of
services to low-income uninsured clients. Services to address depression, violence, substance abuse and other
related issues must be delayed due to funding barriers.
Ionia Intermediate School District, Gratiot County Mental Health, Catholic Social Services and EightCAP,
Inc. offer services to families through grant-funded initiatives on a limited basis. For those services, familycentered practice is used as a way of working with families, both formally and informally, across service
systems to enhance their capacity to care for and protect their children. It focuses on the needs and welfare of
children within the context of their families and communities. Family-centered practice recognizes the
strengths of family relationships and builds on these strengths to achieve optimal outcomes. Family is defined
broadly to include birth, blended, kinship, and foster and adoptive families.
Family-centered practice includes a range of strategies, including advocating for improved conditions for
families, supporting them, stabilizing those in crisis, reunifying those who are separated, building new
families, and connecting families to the resources that will sustain
Appendix E
6.
Children’s Behavior and Well Being
As social policies implemented under devolution affect adults, it also affects children. Clearly, the behaviors,
resources, and well-being of adult family members help shape each child’s environment. In turn, the family
environment may ultimately affect performance in school, social and emotional adjustment, health, and other
dimensions of child well-being.
The latest National Survey of America’s Families (although this project has not recently been updated, it still
provides a “look-see” into the human side of Michigan families) prepared a “snapshot” of America’s families,
addressing two areas of concern to early childhood education advocates – children’s behavior and well being,
and children’s family environment. Although it was not possible to conduct individual assessments or
personal interviews with children themselves, the NSAF incorporated a limited but carefully selected set of
measures to provide a picture of child well-being during this period of devolution. Based on questions that
parents answered about their children, the following measures were constructed for Children’s Behavior and
Well Being:

Engagement in school (ages 6-17)
Participation in at least one extracurricular activity in the past year (ages 6-17)
Levels of behavioral and emotional problems (ages 6-17)
Skipping school once or more in the past year (ages 12-17)
Expulsion or suspension from school in the past year (ages 12-17)
Fair or poor child health (ages 0-17)
These measures tap crucial aspects of child well-being. For example, high engagement in school is associated
with better school performance and postponed pregnancy (Connell, Spencer, and Aber1994;Manlove 1998).
Participation in extracurricular activities has been linked to improved academic performance, reduced rates of
early dropout and criminal arrest, and lower risk of school-age motherhood (Eccles and Barber 1999;
Mahoney 2000; Moore et al. 1998). Behavioral and emotional problems have been associated with lower
literacy scores, persistent behavior problems, and maladjustment in later development (Ferdinand et al. 1999;
Baydor, Brooks-Gunn, and Furstenburg 1993)
According to the National Survey of America’s Families, 42% of six to eleven-year-olds in the United
States were highly engaged in school. Differences did occur by income, with as much as a five point,
upward span between engaged low-income and high-income children. This gap was consistent from
studies completed in 1997, despite a 4 percentage point drop among higher-income peers.
Eighty-one percent of U.S. six to eleven-year-olds had engaged in one or more extracurricular activities in
the previous year. Activity involvement, like school engagement, varied by income: 91% of higherincome children, as opposed to 67% of low-income children, had participated in at least one activity.
While this decline may reflect behavioral changes, it also may reflect reduced access to sports, music, and
arts programs for low-income children.
Only six percent of 6 to 11-year-olds exhibited high levels of behavioral and emotional problems in the
nation, consistent with information presented in 1997. The problems were more common, however, to
low-income youngsters, at 9%, than higher-income youth at 4%.
Most surveyed children, 6-11, were relatively healthy in 1999; just 4% were described as being in fair or
poor health nationally. Low-income children, however, were more than three times as likely to be in less
than good health than their higher-income peers. A similar trend existed for children under six.
In the 13 states surveyed, state levels differed from the national average by fewer than 5 percentage points
on any given measure. NSAF data specific to Michigan includes:
Appendix E
Indicator: Children’s Behavior & Well
Being
All Incomes
(%)
*Low-Income
(%)
HigherIncome (%)
Children ages 6-17 highly engaged in school
41.9
33.2
46.1
Children ages 6-17 participating in
extracurricular
85.1
71.7
91.7
Children ages 12-17 expelled/suspended
14.0
23.3
10.2
Children ages 12-17 skipped school 1+
15.4
21.8
12.7
Children ages 6-11with high levels of
behavioral or emotional problems
8.6
13.3
5.9
Children ages 12-17 with high levels of
behavioral or emotional problems
5.8
9.1
4.5
Children’s environments are closely tied to the behaviors and well-being of the adults in their homes, and
the environments in which children live affect their well-being (Child Trends 1999). Of the family
environment measures in the National Survey of America’s Families, only a few indicators changed
nationally, for the population as a whole. There has been little progress, it was determined, in meeting
two goals of welfare reform: Both the child poverty rate (Zedlewski 2000) and the percentage of children
living in single-parent families has remained constant. At the same time, parental aggravation increased
slightly nationwide.
Overall, the NSAF showed very similar patterns during the earlier and later studies. For both project
periods, children who lived in families with low-incomes or with a single parent experienced, on average,
much more disadvantaged family environments than did other children. Low-income children became
less likely to live with a single parent, but other aspects of their family environments did not change.
Meanwhile, among higher-income children, the prevalence of high parental aggravation rose while
infrequent reading to young children increased during the study.
Why might the quality of children’s family environments appear static – or even worsen – given the
economy and rates of poverty and single parenthood during the period studied? Several possibilities
exist: It may take more than two years for changes in the family environment measures examined to
register; the measures may be sensitive only to larger changes in income, family structure, or other
societal forces; and improvements in children’s family environments in one group may offset declines in
others.
As reported by their parents, the “snapshot” of Children’s Family Environment analyzed family
environments of low-income children with those of higher income children. It also compared singleparent versus two-parent family environments.
Structured measures included:

Family structure (with children ages 0-17)
Frequency with which parents read or tell stories to their children (w/c ages 1-5)
Frequency with which parents take their children on outings (w/c ages 0-5)
Parental involvement in volunteering (ages w/c 0-17)
parental attendance at religious services (w/c ages 0-17)
Level of parental aggravation (w/c ages 0-17)
Symptoms of poor parental mental health (w/c ages 0-17)
Family environments in the United States reveal that single mothers are disproportionately likely to be
poor, and poverty is associated with a host of negative outcomes among children (McLoyd 1998).Appendix
By theE
same token, children living with two biological parents are much more likely to experience a variety of
positive outcomes. In the U.S. overall, 64% of minor children lived with two biological or adoptive
parents in 2000, while 8% lived in a blended family. Twenty-five percent lived with a single biological
or adoptive parent, and the remaining 4% lived with other adults or alone. Higher-income families
remained intact 75% of the time, compared to a rate of 47% for low-income families. Similarly, about
three times as many low-income children lived with a single parent as did higher-income children.
Reading or telling stories to young children can help them develop their linguistic, cognitive, and literacy
skills (National Center for Education Statistics 1998). Throughout our nation in 1999, 18% of children 1
through 5, consistent with 1997 rankings, lived with parents who read or told stories to them on fewer
than three days per week. This proportion was nearly twice as high for low-income as for other children:
24% versus 13%. It is interesting to note that this measure worsened by about 2 percentage points from
1997 to 1999 for higher-income families. Children living with a single parent were even more likely to
be read to infrequently, about 24%.
Taking young children on outings is important because it can stimulate their cognitive development
(Bradley and Caldwell 1980; Bradley et al. 1988). In both 1999 and 2000, 16% of all American children,
0-5, were taken on outings to the park, grocery store, church, or a playground less frequently than two or
three times a month. Twenty-two percent of low-income youngsters were taken on outings infrequently,
compared with 12% of higher-income children. 20% of single parent families took infrequent outings,
contrasted with 15% in two-parent families.
By volunteering, parents are positive role models for their children. Nationwide, 38% of children under
18 lived with a parent who volunteered at least a few times a month, the same percentage as 1997.
Twenty-seven percent of single parents volunteered regularly, while 42% of two-parent families
participated. The gap between income groups: 30%/ low-income families; 43% higher-income peers.
Parental religiosity has been associated with many positive child outcomes, including cognitive and social
competence, avoidance of early sexual activity, adolescent social responsibility, and a reduced incidence
of depression. One way to measure religiosity is to determine frequency of participation in religious
activities. Nationally, 59% of all minor children lived with a parent who attended at least a few religious
activities a month. 49% of children in single-parent families had a parent who attended regularly,
compared to 62% in two-parent families. The percentages are 54% among low-income children and 62%
among higher-income children. This measure remained constant between 1997 and 1999 in all cases.
A parent who reports frequently feeling stressed or frustrated by the experience of caring for children is
defined as having a high level of parental aggravation. Children of highly aggravated parents are
disproportionately likely to have cognitive and socio-emotional difficulties (McGroder 2000). In 1999,
nationwide, 10% of children under age 18 lived with a parent who felt highly aggravated. Children living
with a single parent were more than twice as likely to have a highly aggravated parent as children living
with two parents (16 versus 7 percent). Similarly, low-income children were twice as likely as other
children to live with a highly aggravated parent (14 versus 7 percent). Since 1997, the proportion of U.S.
children with highly aggravated parents has increased slightly but significantly, and is concentrated
among children living with two parents and particularly among higher-income children with two parents.
Children who have clinically depressed parents or parents reporting symptoms of depression are at risk
for a variety of negative outcomes, including health, cognitive, and socio-emotional problems (Downey
and Coyne 1990). The National Survey of America’s Families included a mental health scale based on
parents’ responses to questions about their feelings in the past month. Results included:
9
9
9
9
16% of children under 18 had a parent who reported symptoms of poor mental health in 1999.
Children living with single parents were more than twice as likely to have a parent reporting
symptoms of poor mental health (27%) than two-parent families (11%).
10% of children living in families with incomes over 200% of poverty had a parent reporting
symptoms of poor mental health, compared with 25% of low-income families.
Appendix E
There was no change between 1997 and 1999 on this measure at the national level across family
structure or income groups.
The NSAF revealed substantial variations in children’s environments across the 13 states studied. Data
specific to Michigan includes:
Indicator: Children’s Family Environment
All Incomes
(%)
*Low-Income
(%)
HigherIncome (%)
Children in two parent families
63.5
42.4
74.6
Children in single parent families
24.3
45.2
13.2
Children, 1-5, read/ stories less than 3X per
week
12.4
15.9
10.2
Children, 0-5, taken on outings 3X month or
less
18.0
25.8
13.2
Children w/parent who volunteers few times
month
39.4
35.1
Children w/parent attends religious services at
least a few times per month
53.8
46.8
57.6
Children with a parent who is highly
aggravated
8.7
13.9
6.0
16.0
23.6
11.9
Children with parent reporting symptoms of
poor mental health
* (below 200% of poverty)
41.7
These findings suggest that, while the population of children living in low-income or single-parent
families has diminished slightly, there have been few other significant changes in children’s
environments. Despite some worsening in the environments of children in families with incomes above
200% of poverty, these higher-income children continue to be far better off on average than low-income
children. Indeed, low-income children fare worse on every measure examined. Findings from the
National Survey of America’s Families suggest a strong link between family structure and other aspects
of children’s environments that may affect their well-being.
Research indicates that family environments and parents exert an important influence on the development
of children (Collins et al. 2000). Continued tracking and research will determine whether income and
family structure changes will ultimately change family environments and child outcomes.
Profile of “at risk” Families – 0-5 years of age
The profile of an “at risk” family is changing; many must secure full-time employment with minimal or
no fringe benefits. Since most must travel a distance to their jobs, maintenance and insurance of a vehicle
creates a new obstacle. Quality child care weighs heavily on the minds of families. Parenting, especially
for single, female, head-of-households offers challenges with fewer resources available from state
protective services workers. Reductions in food stamp benefits and vendor payments to utility companies
has created additional stresses for families.
A typical one-parent family consists of an unemployed Mom with 2 children, at least one of which is
under age 5. Mom has graduated from high school, is employable, but does not have marketable skills.
She receives monthly support checks, but no monthly TANF reimbursement. Her children are insured
through the Federal Medicaid program. WIC and commodity distribution supplement the monthly
food E
Appendix
needs. Because there is no dentist who will see her children locally, their teeth have gone unattended.
The closest HMO physician is 12.5 miles, which is difficult with less than dependable transportation.
The two-parent family fairs slightly better with a male, full-time employed head of household.. Their
three children are insured through Medicaid until the income level is exceeded, and then they will be
uninsured. Mom can provide care in the home, but must faithfully follow a very limited budget, since the
family income hovers around 150% to 200% of poverty. They are on the list for home energy
weatherization. Transportation is accomplished through one car, and assistance provided by relatives and
friends. No monthly TANF check is received. Similar medical and dental issues face this family as well.
The educational level of both parents is high school completion or lower, and the prospects for job
advancement are slim due to low skills.
Appendix E
EightCAP, Inc. Head Start
County 2009-10 Needs Assessment Survey Results
County: Gratiot/Ionia/Isabella/Montcalm
Total surveys received:
1. Single
Married
Divorced
Widowed
Separated
Total Responses
2. How many people are living in your home?
2009-10
1154
Total
414
561
100
8
60
1143
%
36%
49%
9%
1%
5%
Range from 2-12
people.
3. Children's ages:
0-2
3-4
5-12
12-17
18+
Total Responses
457
1049
514
128
39
2187
21%
48%
24%
6%
2%
4. Own their home.
737
64%
5. Home is:
Single dwelling
Duplex
Mobile
Apartment
Total Responses
637
45
215
213
1110
57%
4%
19%
19%
Range from 2 days to
6. How long have you lived at your current address? 32 years.
7. Homes that have been Weatherized.
283
25%
8. Number of adults that are employed:
At least one adult is employed full time
At least one adult is employed part time
Total Responses
664
245
909
73%
27%
998
45
8
83
39
1173
85%
4%
1%
7%
3%
9. Type of transportation used:
Own vehicle
Public transportation
Car pool
Neighbor/friend
Other
Total Responses
County: Gratiot/Ionia/Isabella/Montcalm
Total surveys received:
2009-10
1154
Appendix E
EightCAP, Inc. Head Start
County 2009-10 Needs Assessment Survey Results
10. Type of insurance:
Medicaid
Medicare
Private
CSHCS
Other
Total Responses
Total
838
36
293
31
139
1337
%
63%
3%
22%
2%
10%
11. In the past 2 years members of household have:
Had difficulty in obtaining medical services
Used the emergency room
Received a shut-off notice from a utility company
Been homeless
Been without heat
Used a food bank or pantry
Total Responses
143
889
560
79
128
409
2208
6%
40%
25%
4%
6%
19%
12. Have completed the following schooling:
6th grade
7-8th grade
9-10th grade
11-12th grade
College
Total Responses
2
10
69
571
490
1142
0%
1%
6%
50%
43%
13. Seeked employment from:
Michigan Works
Friends/family
Newspaper want ads
All of the above
Total Responses
78
33
70
898
1079
7%
3%
6%
83%
14. Are in need of child care:
146
13%
11
1%
15. Other older children in need of child care
after school:
Appendix E
VII
Early Childhood Education and Child Care
Availability
Approximately 63,780 children 0-17 reside in the counties of Gratiot, Isabella, Montcalm, and Ionia. At
least 20% of those children reside in homes with incomes below poverty guidelines. Available, free early
childhood education spaces in the EightCAP service delivery area for 0-5 year-olds are as follows:
Early Head Start
Other 0-3 Projects
Head Start
Michigan School Readiness
120
140
739
553
Child care and private pay preschool slots available include:
Licensed Child Care *
Private Pay Preschool
5,819
428
*Licensed child care includes center and home-based care.
Note that the majority of Head Start and Great Start School Readiness programs do not provide full-day
care, but operate in sessions of two and a half to seven hours. Parents who need more than half-day child
care must provide other arrangements for their children. Programs coordinate with child care providers
whenever possible, such as in transportation arrangements.
The breakdown of area FIP eligible children, 0-5, is a s follows:
County
0–1
1–2
2–3
3–4
4–5
Gratiot
128
186
140
143
122
Isabella
179
215
199
169
178
Montcalm
183
191
204
179
185
Ionia
188
190
209
197
192
Michigan has awarded funding to intermediate school districts to coordinate parenting education activities
for parents and care givers of children, 0-6. The future is unclear, at this point, as to the viability of
Michigan’s “Great Parents – Great Start” program.
Child Care Need
According to the State of Michigan Family Independence Agency, there is need for additional child care
slots in all the Michigan counties. Local area impact studies found that, while precise predictions of
future child care demand cannot be made with the data at hand, the relatively low unemployment rate in
the area and the population increase resulting from fuller employment are likely to lead to a greater
demand for child care over the next few years. In addition, it should be noted that many area employees
work evening or night shifts, when most licensed child care is not available.
The availability of regulated child care for infants and toddlers is virtually non existent in Gratiot,Appendix E
Isabella, Montcalm, and Ionia Counties. Care is generally provided by relatives, friends, or neighbors.
Average monthly cost in the following counties for the care of one child is as follows:
Gratiot
Isabella
Montcalm
Ionia
Program/Families
$409
$604
$403
$424
% Working/Full-time
or Part-time
Percentage w/
“Stay-at-home” Parent
Early Head Start
57%
42%
1%
Head Start
65%
32%
3%
Involved w/ Schooling
The 2007 Kids Count data book reported that among needy families, the working poor are least likely to
receive assistance with child care costs, despite the indication by the 2000census that 60% of the working
poor earn less than $7 per hour, meaning that their net wage barely covers their child care costs. Child
care problems are becoming increasingly difficult for recipients of public assistance who are being
required to work, and employed single mothers at or near the poverty level face continuing hardships in
combining work with parenting. They have reported particular concern about current child care
arrangements and the most hardship in affording quality child care.
8.
Educational Opportunities
Michigan offers a free K-12 public school opportunity to all students; disabled children, ages 0-26 receive
special education services. Schools of choice allow parents to select the educational setting they feel is
most suited to their child’s needs.
Early Care and Education Usage Patterns of Children from Low-Income Families
Participation in early care and education settings is common for children from low-income families.
More than half of children younger than 6 in low-income families are regularly left in early care and
education settings. More than a third of all children in low-income families in this age group are in such
settings for more than 15 hours a week. Children in low-income families are found in all types of care,
including center-based arrangements, family child care, and care by relatives and non relatives in home
settings. More than a third are in more than one arrangement regularly.
Patterns of early care and education differ for families with higher and lower incomes.
Low-income children, younger than 5, in families with employed mothers are slightly less likely to be in
early care and education settings overall, and more likely to be in relative care. Higher-income
counterparts are more likely to take advantage of center-based care. Child care patterns also differ by age,
parental marital and work status, and race or ethnicity.
The use of particular early care and education arrangements reflects access to different arrangements as
well as family preferences and constraints.
Some factors that play a role in type of care used include the family’s financial situation and access to
child care subsidies; the employment status and schedules of parent(s); whether another parent or relative
can provide care; the supply, cost, and quality of different care options available in the community or near
parents’ employment; access to information about care options; the location of the care and the
availability of transportation; parents’ preferences and the care they are comfortable with for the child;
Appendix E
and special needs of the child or children.
Early care and education has become a reality for many young children in America as increasing
proportions of families have working parents. At the same time, a growing body of research shows the
importance of the early years for children’s future development, with some findings indicating that highquality early care and education can be particularly important for the development of children in lowincome families. In addition, the United States is investing billions in public funds to support early care
and education with a particular emphasis on children in low-income families.
Well-designed educational programs for young, economically disadvantaged children can clearly
affect their lives for the better, both during their school years and beyond. These programs also
enhance the development of other children, particularly the disabled. Economic analyses indicate
that providing such programs is an excellent investment in the future of our society (Barnett and
Escobar, 1987).
The findings regarding effective practices in early childhood programs are congruent with those
effective schooling research findings that have relevance for young children. Both bodies of
literature identify the following as critical components of effective schooling:
•
Matching instructional resources and teaching activities to the developmental
levels of the children;
•
Holding high expectations for all children and taking steps to insure that they will
be prepared for success at their next level of education;
•
Making sure that activities flow from previous activities and learnings into future
ones; explaining these connections to the children as part of the activity;
•
Previewing lessons, giving clear directions, and checking student understanding;
•
Allowing children plenty of opportunity for guided and independent practice with
new concepts and skills;
•
Monitoring student activities and providing help as needed;
•
Communicating warmth and caring to children;
•
Building good continuity across grade levels and making sure teachers know
where their curriculum fits into the overall school curriculum;
•
Allocating and making use of time in ways that meet program goals;
•
Providing staff development opportunities with an emphasis upon skill building;
and
•
Engaging the involvement of parents, providing them an array of involvement
opportunities, and building teachers' capacity to work effectively with parents.
It is essential that our society be willing to make long-range investments in our children and in
the quest for ways to improve their ability to succeed in life.
Children with Disabilities
The Gratiot-Isabella Regional Education Service District is designated to provide administrative and
instructional resources and services to local schools so that they may continue to offer high quality
Appendix E
learning experiences to their communities. This function is carried out in Montcalm County by the
Montcalm Area Intermediate School District and Ionia County by the Ionia Area Intermediate School
District. Responsibility for services to children with disabilities is divided between local education
authorities and the intermediate school districts.
Approximately 7,000 children with disabilities received special education services from local and
intermediate school districts in the 2006-2007 school year. The only county to experience a reduction in
special education students was Isabella.
The largest category of disability was specific learning disabled, followed by speech and language
impaired, educable mentally impaired, physically or otherwise health impaired, emotionally impaired,
trainable mentally impaired, severely multiply impaired, autistic impaired, hearing impaired, severely
mentally impaired, and visually impaired. All of the preschool children were labeled pre-primary
impaired.
Local educational authorities (LEA’s) and ISD’s (Intermediate School Districts) provide necessary
special education services for children with disabilities, as required by Michigan law. Any special
accommodations required for children to fully participate in an educational program is the responsibility
of the LEA/ISD; other auxiliary aids and services are negotiated with the local programs, such as Head
Start, as needed.
Dropping out of high school is related to a number of negative outcomes. For example, the average
income of persons ages 18 through 65 who had not completed high school was roughly $20,100 in 2005.
By comparison, the average income of person’s ages 18 through 65 who completed their education with a
high school credential, including a General Educational Development (GED) certificate, was nearly
$29,700 (U.S. Census Bureau, 2006). Dropouts are also less likely to be in the labor force than those with
a high school credential or higher and are more likely to be unemployed if they are in the labor force
(U.S. Department of Labor, 2006). In terms of health, dropouts older than age 24 tend to report being in
worse health than adults who are not dropouts, regardless of income (U.S. Department of Education,
2004). Dropouts also make up disproportionately higher percentages of the nation’s prison and death row
inmates.
High school graduation statistics are generally consistent in the service area, as the Michigan Department
of Education and No Child Left Behind statutes demand an increase in high school graduation rates:
Gratiot
Isabella
Montcalm
Ionia
State of Michigan
83.5%
86.1%
81.2%
83.4%
83.4%
Adult Education
Adult education in Michigan has changed considerably in the past five years. Funding has decreased to a
standard state aid amount, causing districts to reduce the programming available to adults seeking their
high school diploma. Additionally, the numbers of youth who are quitting traditional school to complete
their education in alternate settings are increasing; children as young as 13 can be found in alternate
education programs in Michigan.
Charter schools are increasingly serving the needs of educationally disadvantaged youngsters in
Michigan. Often enrolling youth who make little or no progress in standard public education settings,
charters are exploring new teaching and service delivery models that meet the needs of enrolled pupils.
Montcalm and Mid-Michigan Community Colleges allow students to secure basic courses prior to
Appendix
attending university or to be granted an associates degree in a technical field. EightCAP, Inc. Head
Start E
assisted Montcalm Community College in setting up its Child Development Associate program, and has
operated a collaborative child care program on campus since Fall, 2001. Those students seeking a fouryear degree might attend Central Michigan University or privately operated Alma College. Financial aid
in the form of loans, grants or scholarships are available to offset the rising costs of further education.
Head Start has held formalized community partnership agreements with the following institutions of
higher education:
Central Michigan University
Alma College
Michigan State University
Montcalm Community College
Grand Valley State University
Employment and training programs, such as the Workforce Development Act (WDA), can facilitate trade
or higher education for residents of the four-county service area. Depending on the locality, grants are
received to retrain displaced workers or transition the unemployed into new vocations. It is not yet clear
what opportunities new training programs might offer area residents.
Work First is the Michigan program developed to reform the welfare system. Persons receiving state
assistance must comply with Work First requirements, including a minimum amount of employment in
the private sector or community service activities; the emphasis, however, is on employment. All
EightCAP, Inc. service area Counties have been designated Project Zero sites by the Family
Independence Agency. Intense efforts will occur in these counties to bottom-out the number of residents
receiving welfare benefits.
IX.
Conclusions
The geographic area served by EightCAP, Inc. is rural and predominantly farm land and light industry.
Caucasians make up 88% of the population, with minorities comprising 12%. On average the population
is growing at a rate of 15%.
The well being of children has worsened in poverty levels. Some improvements have been seen in teen
births, prenatal care and child immunizations. Family structure and environment play an important role in
child outcomes.
The numbers of young children with disabilities has increased, except in Isabella County; special
education programs for pre-primary impaired youngsters generally cannot keep up with the demand for
services. Schools of choice are increasing the options available to parents for the education of their
children. State work-for-aid requirements remain constant. Retraining, in light of the loss of the
manufacturing base in Michigan, is increasing at a fast pace.
The need for quality, affordable child care continues to grow. Although, a high percentage of parents
with infants and toddlers provide care for their children at home with either the biological mother or
father.
The following conclusions may be drawn from this assessment of community needs:
1.
2.
3.
4.
5.
6.
A lack of quality, affordable and developmental early childhood education, including parent/child
interactions, preschool experiences, and appropriate parental expectations delays the development of
children;
Inadequate education, including life experiences, is a barrier to self-sufficiency;
Parenting and life coping skills must be enhanced for families to reach their fullest potential;
A disproportionate amount of economically disadvantaged families’ incomes must be spent to heat and light
their homes, leaving less money for family enrichment/learning activities;
Insufficient health care retards normal growth and development of children and cripples families; Appendix E
The lack of transportation prohibits families from accessing services critical to their families; and
7.
Low-income residents, including welfare recipients, must receive appropriate education, employment and
training services to move successfully into the work force.
Goals and critical objectives addressing the barriers faced by mid-Michigan families will be carried out within this 05-year-old Head Start program.
Resources
Data for this needs assessment was gathered from the following sources:
Annual Planning Information Report 2006, 2007, State of Michigan
Annual Report, 2006, Office of Children’s Ombudsman, State of Michigan
Babycenter.com, 2007
Casino Impact Study, Center for Applied Research and Rural Studies, Central Michigan University
2000 U.S. Census and Census Estimates
Department of Housing and Urban Development 2007
Child Trends 2007
Economic Self-Sufficiency: A Michigan Benchmark, Michigan League of Human Services
EightCAP, Inc. Head Start Family Needs Assessment Survey 2009-2010
EightCAP, Inc. Weatherization and Community Services Programs 2009-2010
Innovative Practices With Vulnerable Children and Families, 2001
Kids Count in Michigan 2007 Data Book
National Survey of America’s Families 1999-2004
Appendix E
Appendix F
Appendix G
Appendix G
Appendix G
Appendix G
Appendix G
Appendix G
Appendix G
Appendix G
Ionia County Behavioral Risk
Factor Survey
Research Results from the 2010
BRFS Survey
Appendix H
Background and Objectives

The Carl Frost Center for Social Science Research was contracted by the
Ionia County Health Department to conduct a Behavioral Risk Factor Survey
(BRFS) of a random sample of Ionia County residents.

The Ionia County Health Department is a leader in improving the health and
well-being of the community by:




Protecting residents from health threats
Providing healthy solutions for everyone
Educating people about good health
Advancing community health through the development of new policies and
standards

The Behavioral Risk Factor Survey is conducted periodically to collect
population-based estimates of the prevalence of various behaviors, medical
conditions, and preventive health care practices among Ionia County
residents.

BRFS results will be used by the Ionia County Health Department to assess
the needs of the community it serves as well as to develop and evaluate
programs that promote the health of Ionia County residents.
Appendix H
Carl Frost Center for Social Science Research
2
Methodology

Research was conducted via a telephone survey of a random sample of Ionia
County residents.

A random digit dialing (RDD) sample of telephone numbers was purchased
from Survey Sampling, Inc. from which the telephone numbers were drawn.

A total of 810 Ionia County residents completed the survey, 537 females
(66%) and 273 males (33%).

The 810 households represent 3.9% of the 20,606 households in Ionia
County according to the 2000 U.S. Census.

The same survey that was used in 1995, 1999, and 2006 by Ionia County
was used this year, with minor changes and additions. This allows to trend
the measures over time and note any significant changes.

Unless noted, as in the Michigan BRFS, respondents who refused to answer
a question or did not know the answer to a specific questions were normally
excluded from analysis, thus the base sizes vary throughout this report.
Appendix H
3
General Health Perceptions
Appendix H
Eight in ten Ionia County residents consider their general health to be good or
better, with 12% reporting it as “excellent.” Still, this measure has declined
substantially since 1995.
Perception of Personal Health
Perceptions of General Health Over Time
(% Good/Very Good/Excellent)
Perception of General Health in 2010
100%
90%
Excellent
87%
12%
82%
82%
Very Good
34%
50%
Good
36%
13%
Fair
Poor
82%
6%
(n=806)
0%
1995
(n=406)
1999
(n=411)
2006
(n=862)
2010
(n=806)
Appendix H
Q65: Would you say that in general your health is…?
5
Health Conditions
Appendix H
The prevalence of conditions such as depression, abuse, neglect, and
dementia have declined slightly from 2006. Yet, more than one-third (35%) of
Ionia County residents have experienced depression.
Health Conditions Experienced
Over Time
35%
Depression
32%
8%
Abuse
6%
Neglect
4%
2006 (n=522)
2010 (n=810)
2%
Dementia
1%
1%
60%
None of these
62%
Appendix H
Q179: Have you ever experienced any of the following in yourself?
7
Blood Cholesterol, Blood Pressure,
and Diabetes
Appendix H
Nearly all Ionia County residents have had their blood pressure checked. Nine in ten
(90%) have had their cholesterol checked and this proportion has increased over the
years. Prevalence of high cholesterol, diabetes, and high blood pressure have all
increased steadily since 1995.
Prevalence of High Cholesterol, Diabetes, and High Blood Pressure
Measures Checked Over Time
(% Yes)
100%
99%
99%
100%
89%
80%
99%
High Cholesterol, Diabetes, and High Blood
Pressure Over Time
(% Prevalent)
100%
High Cholesterol
90%
Diabetes
High B/P
78%
50%
50%
50%
34%
37%
26%
49%
43%
23%
Cholesterol Checked
29%
B/P Checked
12%
14%
16%
5%
0%
0%
1995
(n=406)
1999
(n=407)
2006
(n=866)
2010
(n=810)
1995
Q41: Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?
Q49 Have you ever had your blood pressure checked?
Q43: Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?
Q45: Have you ever been told by a doctor, nurse, or other health professional that you have diabetes?
Q51: Have you ever been told by a doctor, nurse, or other health professional that you have high blood pressure?
1999
2006
2010
In 2010, 7% of women were told
they had diabetes only during
pregnancy. Additionally, 4% of
women were told they had high
blood pressure only during
Appendix H
pregnancy.
9
Health Behaviors
Appendix H
Weight
Appendix H
Seven in ten (70%) Ionia County residents are overweight or obese, and this
hasn’t fluctuated much since 2006. The good news is that the majority of the
people who are obese or overweight are attempting to lose weight.
Weight Status
Weight Status Over Time
(Calculated Using BMI)
32%
Obese
Overweight
Normal
Underweight
35%
Attempting to Lose Weight by
Weight Status (2010)
(% Yes)
49%
Total (n=805)
35%
35%
31%
29%
2%
2006
(n=839)
1%
2010
(n=781)
A. Underweight
(n=8)*
B. Normal
(n=225)
C. Overweight
(n=271)
D. Obese
(n=274)
Q55: About how much do you weigh without shoes?
Q63: About how tall are you without shoes?
Q59: Are you now trying to lose weight?
12%
20%
51%
71%
Appendix H
12
In order to lose weight, most people opt for eating fewer calories and more
exercise. Between one-third and half specifically eat less fat and/or fewer
carbohydrates.
Actions Taken to Lose Weight
Other Mentions
65%
Eating Fewer Calories
Eating less food, n=6
Weight Watchers/support groups, n=6
64%
Engaging in Physical Activity
Eat healthier foods (e.g., more fruit, more
vegetables, whole grain pasta), n=3
Eat more fiber/protein, n=3
48%
Eating Less Fat
Surgery/gastric bypass, n=2
Diabetic diet, n=2
Stop eating sugar, n=1
Eating Fewer Carbohydrates
37%
Less processed food, n=1
Less junk food, n=1
Less salt, n=1
Other
Base: those trying to lose weight
7%
(n=395)
Appendix H
Q61: To lose weight, are you…?
13
Physical Activity
Appendix H
Three-fourths of Ionia County residents participate in aerobic exercise an average of nearly
17 times per month. Average time spent exercising is nearly an hour (54 minutes). Popular
non-aerobic physical exercise includes a variety of activities such as housework, gardening,
and lawn care.
Participation in Physical Activity
Participation in Aerobic Activities
in Past Month Over Time
Participation in Non-Aerobic Physical
Activities in Past Month (2010)
Housework
Yes
No
83%
82%
78%
17%
18%
Yes,
88%
22%
1995
(n=406)
1999
(n=411)
2006
(n=863)
78%
22%
2010
(n=810)
Average Number of Times Per Month (2010) = 16.6, (n=619)
17%
Work
11%
Gardening
10%
Lawn care/mowing
10%
Weightlifting
6%
Childcare
5%
Bicycling
5%
Golf
3%
Team Sports
2%
Other
Average Number of Minutes Per Activity (2010) = 54.2, (n=618)
Nothing
10%
21%
Q67: During the past month, did you participate in any physical activities or exercises such as walking, running, swimming, calisthenics or other aerobic activities?
Q69: How many times per week or times per month did you take part in this activity during the past month?
Q71: When you took part in this activity, for how many minutes or hours did you usually keep at it?
Q73: What other type of physical activity gave you the next most (or any) exercise during the last month?
(n=682)
Appendix H
15
Nutrition
Appendix H
The majority of Ionia County residents have 1-2 servings of vegetables per
day. Residents average almost four servings per week of red meat, but this
rate has dropped slightly over the years.
Average Servings of Meat Per Week
Servings of Vegetables Per Day
4%
8%
14%
5%
8%
10.0
17%
8.0
6.0
61%
4.2
64%
4.3
3.9
4.0
3.7
3.3
3.5
2.0
13%
2006
(n=849)
6%
2010
(n=794)
Red Meat
White Meat
0.0
1999
1995
2006
5 or More Servings
4 Servings
No Red Meat
6%
3 Servings
1 to 2 Servings
No White Meat
4%
None
Q75: Excluding potatoes, corn, peas, and beans, how many servings of vegetables do you usually eat per day, including fresh, frozen, canned, or juice?
Q77: How many servings of red meat (that is, beef, pork, lamb) do you eat per week?
Q78: How many servings of white meat (that is, chicken, turkey) do you eat per week?
2010
7%
4%
Appendix H
17
Dining Out
Appendix H
Nine in ten Ionia County residents dine out at least once a month. The
average of six times per month is down slightly from 2006.
Dining Out
Dining Out Behavior
Over Time
Don’t Dine Out
1 Time
Per Month
2006 (n=851)
2010 (n=810)
2 Times
Per Month
3 Times
Per Month
10%
10%
9%
13%
12%
14%
8%
7%
25%
4 Times
Per Month
5 to 9 Times
Per Month
10 or More Times
Per Month
Number of Times Dine Out
Per Month Over Time
(Mean)
26%
16%
15%
6.5
5.9
2006
(n=767)
2010
(n=730)
Base=dine out at least once per month
21%
15%
Appendix H
Q155: How often do you dine out (at a regular or fast food restaurant) per week or month?
19
Tobacco Use
Appendix H
In general, tobacco use has declined slightly over the last 15 years, yet this is still on
par with 2006 prevalence. Cigarettes are the tobacco product of choice, by far, and
those who use cigarettes smoke an average of 14 times per day.
Current Tobacco Use
Current Tobacco Use Over Time
(% Use)
Average Number of Times
Per Day Tobacco
Products Used in 2010
Tobacco Products
Currently Use in 2010
Cigarettes
81%
14.2
(n=132)
26%
26%
21%
20%
Chewing
Tobacco
13%
6.7
(n=19)*
1995
(n=406)
1999
(n=411)
2006
(n=863)
2010
(n=810)
Cigars
6%
7.6
(n=9)*
Pipe 1%
30.0
(n=2)*
(n=165)
Base=tobacco users
Q79: Do you currently use tobacco products?
Q83: Which tobacco products do you use?
Q85: On average, how many times a day do you use this (these)?
Appendix H
21
Current smokers generally took their first puff at age 16. The fact that most
smokers (86%) began smoking before the age of 18 sheds light on how easy
it is for underage teens to obtain cigarettes.
Age at Which First Smoked Cigarettes
Age First Smoked Cigarettes
Over Time
Under 10
5%
7%
10 to 11
8%
7%
12 to 13
2006 (n=160)
2010 (n=147)
12%
16%
28%
22%
14 to 15
20 to 21
22 or Older
16.1
15.7
2006
(n=160)
2010
(n=147)
19%
23%
16 to 17
18 to 19
Age First Smoked Cigarettes
Over Time
(Mean)
12%
12%
6%
7%
11%
7%
Appendix H
Q81: If you currently smoke cigarettes, how old were you the first time you smoked, even one or two puffs?
22
Alcohol Consumption
Appendix H
Four in ten (43%) residents drank alcohol at least once in the month prior to the survey,
down slightly from previous years, while 15% have never tried alcohol. Residents who
drink average seven drinks per month, down one full drink from 2006.
Alcohol Use
Number of Days in Past Month
Had at Least One Drink Over Time
(Includes Those Who Don’t Drink)
(Mean)
Drank Alcohol at Least Once in Past
Month Over Time
(% Yes)
4.0
4.0
3.0
1999
(n=388)
2006
(n=856)
2010
(n=800)
3.8
49%
1995
(n=406)
50%
1999
(n=388)
46%
2006
(n=863)
43%
1995
(n=406)
2010
(n=808)
Drank Alcohol in Lifetime (2010) = 85%, (n=809)
Q87: Keeping in mind that your answers are completely confidential, in the past 30 days, have you drunk alcohol?
Q99: Again, keeping in mind that your answers are completely confidential, in your lifetime, have you drunk alcohol?
Q111: During the past month, how many days per week or per month did you drink any alcoholic beverage?
Number of Days in Past Month
Had at Least One Drink Over Time
(Only Those Who Drank)
(Mean)
8.3
7.1
2006
(n=386)
2010
(n=339)
Base=drank alcohol in past 30 days
Appendix H
24
The number of people who binge drink has declined for the county as a whole since 1995. However,
one-fourth (27%) of Ionia County residents who drink alcohol have had 5 or more drinks on at least
one occasion in the past 30 days. This is down from 2006. On average, binge drinkers took part in
binge drinking 4 times in the past month.
Binge Drinking
Had 5 or More Drinks on at Least One Occasion
(Includes Those Who Don’t Drink)
(% Yes)
22%
15%
12%
1999
(n=417)
2006
(n=866)
2010
(n=810)
17%
1995
(n=406)
Had 5 or More Drinks on at Least One Occasion
(Only People Who Drink)
(% Yes)
33%
2006
(n=397)
27%
Number of Times Drank 5 or More Drinks in
Past 30 Days Over Time
(Mean)
4.1
4.1
2006
(n=127)
2010
(n=92)
Base=had 5 or more drinks on at least one occasion in past 30 days
2010
(n=347)
Base=drank alcohol in past 30 days
Q115: Considering all types of alcoholic beverages, during the past month did you have 5 or more drinks on an occasion?
Q117: How many times during the past month did you have 5 or more drinks on an occasion?
Appendix H
25
One in ten have driven a vehicle with children as passengers within 2 hours of drinking
alcohol, while twice as many (21%) have driven within 2 hours of having 5 or more drinks.
Still, even more have been a passenger in a vehicle with someone drunk or high.
Alcohol Consumption and Motor
Vehicle Use (2010)
Driven Motor Vehicle with
Children as Passengers Within
2 Hours of Drinking Alcohol
Driven Motor Vehicle Within 2
Hours After Drinking 5 or More
Alcoholic Beverages
Been a Passenger in a Vehicle
with Someone Drunk or High
Yes, 10%
No, 79%
No, 90%
(n=639)
(n=642)
Yes, 21%
No, 59%
(n=789)
Q121: Have you ever driven a motor vehicle with children as passengers during or within 2 hours of drinking alcohol?
Q122: Have you ever driven a motor vehicle, such as a car, van, truck, or motorcycle during or within 2 hours after drinking 5 or more alcoholic beverages?
Q128: Have you ever been a passenger in a vehicle with someone drunk or high?
Yes, 41%
Appendix H
26
Other Substance Use
Appendix H
Use of substances other than alcohol or tobacco is quite low. Less than 5%
of Ionia County residents have used other substances in the past 30 days.
One-fourth (28%) have used marijuana in their lifetime.
Other Substances Used (2010)
28%
8%
2%
Used Marijuana
Not Prescribed
<1%
2%
Used Inhalants/
Aerosols Not
as Directed
6%
4%
2%
Used Over the
Counter Drugs Not
as Directed
Past 30 Days
Used Prescription
Drugs Not as
Directed or Not
Prescribed to You
<1%
1%
Used
Methamphetamine
Lifetime
(n=810)
Q88, Q92, Q95, Q96, Q97: Keeping in mind that your answers are completely confidential, in the past 30 days, have you….
Q100, Q104, Q107, Q108, Q109: Again, keeping in mind that your answers are completely confidential, in your lifetime, have you…
Appendix H
28
Prescription Drug Use
Appendix H
Prescription drug use is down slightly this year from 2006. In 2010, residents are taking an
average of three prescription drugs. The majority of these are taken for something other than
pain. Those taking prescription drugs average three to four a day and typically get their
prescriptions from one physician.
Prescription Drug Use
Number of Prescription Drugs Used
Over Time
20%
Number of Prescription Drugs Taken
for Pain, Taken Daily and Doctors
Prescribing (2010)
Number
Taken For
Pain
Number
Taken
Daily
Number of
Doctors
Prescribing
(n=578)
(n=578)
(n=577)
None
74%
5%
NA
1
19%
21%
72%
2
4%
21%
24%
3
2%
12%
4%
4
1%
11%
1%
5 or More
<1%
30%
<1%
MEAN
0.4
3.6
1.3
24%
8%
5 or More
4
3
2
1
None
9%
12%
9%
15%
14%
18%
15%
28%
29%
2006
(n=849)
2010
(n=794)
2010 MEAN = 2.8
2006 MEAN = 3.6
Q171: How many prescription drugs do you currently take?
Q173: How many of them are for pain?
Q174: How many of them are taken daily?
Q177: How many different doctors are prescribing medication for you?
Appendix H
30
Substance Abuse Behavior and
Substance Abuse Treatment
Appendix H
Roughly one in seventeen (6%) have received substance abuse counseling or
treatment. Half of these have participated in AA and approximately one-fourth have
received out-patient treatment, individual counseling, and/or group counseling.
Substance Abuse Counseling/Treatment
Have Received Substance Abuse
Counseling/Treatment
Over Time
Type of Treatment Received
(2010)
49%
Alcoholics Anonymous (AA)
7%
6%
Out-Patient
28%
Individual Counseling
Yes
No
93%
2006
(n=857)
94%
2010
(n=810)
26%
Group Counseling
23%
In-Patient
21%
Narcotics Anonymous (NA)
Other
13%
11%
(n=47)
Base=received treatment for substance abuse
Q123: Have you ever received counseling or treatment for a substance abuse problem?
Q125: What type of treatment did you receive?
Appendix H
32
One in twenty have provided alcohol to someone underage. Approximately
the same proportion have been arrested for a substance abuse offense.
Substance Abuse Related Behavior
(2010)
Provided Alcohol to
Someone Underage
Yes, 5%
Been Arrested for a Substance
Abuse Offense
Yes, 6%
No, 94%
No, 95%
(n=808)
Q126: Have you ever provided alcohol to anyone underage?
Q127: Have you ever been arrested for a substance abuse offense?
(n=809)
Appendix H
33
Safety Seats/Seat Belt Use
Appendix H
Most people personally use seat belts when driving or riding in a car and
make sure children are placed in child safety seats. Both of these measures
have improved substantially over time.
Seatbelts and Safety Seats
Frequency of Seatbelt Use Over Time
72%
77%
92%
91%
13%
6%
4%
5%
1995
(n=406)
Children Placed in Child Safety Seats
While Riding Over Time
88%
96%
12%
6%
2%
3%
1999
(n=407)
6%
6%
12%
2006
(n=859)
2010
(n=805)
2006
(n=525)
Always
Almost Always
Sometimes
Seldom
Never
Q129: How often do you use seatbelts when you drive or ride in a car?
Q130: Are children less than 80 lbs always placed in a child seat in cars in which you are riding or driving?
4%
2010
(n=614)
Yes
No
Appendix H
35
Emergency Preparedness
Appendix H
Roughly half of area residents believe they are both prepared for an
emergency in Ionia County and have a plan in place in case of an actual
emergency.
Disaster Preparedness
Family Feels Prepared for an
Emergency/Disaster
Over Time
45%
43%
12%
2006
(n=863)
55%
33%
Family Has Plan in Case of
Emergency/Disaster
Over Time
49%
51%
51%
49%
2006
(n=850)
2010
(n=799)
12%
2010
(n=810)
Yes
No
Don’t Know
Q131: Do you feel that you and your family are prepared if there were an emergency in Ionia County, such as avian flu or a terrorist attack?
Q133: Do you and your family have a plan in case of emergency, such as location for family to meet, water, food, etc.?
Yes
No
Appendix H
37
Home Safety
Appendix H
Four in ten county residents have municipal water. Three-fourths (76%) of those who
don’t have municipal water at least have their water tested. Three in ten (31%)
residents have tested their home for radon, and this has increased since 2006.
Home Safety
Home Has Municipal Water System
Over Time
41%
Have Tested Drinking Water
Over Time
2006
(n=845)
26%
31%
74%
69%
2006
(n=828)
2010
(n=771)
40%
76%
78%
59%
Have Tested Home for Radon
Over Time
60%
2010
(n=799)
22%
24%
2006
(n=487)
2010
(n=470)
Base=do not have municipal water system
Q161: Is your water on a municipal water system?
Q163: Have you ever tested your drinking water?
Q165: Have you ever tested your home for radon?
Yes
No
Appendix H
39
Dental Care
Appendix H
Three-fourths (77%) of Ionia County residents have visited a dentist in the
past two years, although this is down from previous years. The primary
barrier to having routine dental checkups is cost.
Dental Care
Had Dental Checkup in Past Two Years
Over Time
Reasons for Not Visiting the Dentist
(2010)
No Way to Pay for Services
50%
Have Full Dentures
Lack of Dentists Who
Take Medicaid
Yes
No
82%
85%
18%
15%
1995
(n=406)
1999
(n=411)
80%
77%
20%
23%
2006
(n=864)
2010
(n=810)
Did not want to go
27%
9%
5%
Fear of Dental Treatment
3%
Too Busy
2%
Currently Switching Dentists
1%
No Need to Go
1%
Transportation
1%
Other
2%
(n=185)
Base=have not had dental checkup in past two years
Q35: In the past two years, have you had a routine dental checkup?
Q37: What was the reason you did not got in for a routine visit?
Appendix H
41
Prevention and Detection
Behaviors
Appendix H
Mammography
Appendix H
Nearly all females 35 years or older have had a mammogram, whereas very few females
younger than 35 have had one. The number of females, age 18-34, who have had a
mammogram is down substantially this year. On the positive side, the majority of women
who’ve had a mammogram, had it within the past 2 years.
Mammogram Experience
Ever Had a Mammogram (Age 18-34)
Over Time
16%
19%
23%
1995
(n=49)
1999
(n=67)
2006
(n=79)
8%
2010
(n=65)
Ever Had a Mammogram (Age 35+)
Over Time
Time Since Last Mammogram
(Age 18-34) (2010)
From 1 to Less Than 2 years Ago = 100%
(n=3)*
*Caution small base size
Time Since Last Mammogram
(Age 35+) (2010)
61%
Within the Past Year
86%
80%
88%
92%
From 1 Year to Less
Than 2 Years Ago
From 2 Years to Less
Than 3 Years Ago
Than 5 Years Ago
1995
(n=147)
1999
(n=139)
2006
(n=410)
2010
(n=466)
Q135: A mammogram is an x-ray of each breast to look for cancer. Have you ever had a mammogram?
Q137: How long has it been since you had your last mammogram?
5 or More Years Ago
19%
6%
5%
10%
Appendix H
(n=428)
44
Breast Exams
Appendix H
Nearly all females have had a breast exam and the majority have had one in
the past year.
Clinical Breast Examination
Ever Had a Clinical Breast Exam
Over Time
Time Since Last Breast Exam
(2010)
95%
95%
90%
1995
(n=196)
1999
(n=210)
From 1 Year to Less
Than 2 Years Ago
64%
13%
92%
Than 3 Years Ago
2006
(n=521)
2010
(n=537)
Than 5 Years Ago
8%
5%
Base=females
5 or More Years Ago
10%
(n=502)
Q139: A clinical breast exam is when a doctor, nurse, or other health care professional feels the breast tissue for lumps. Have you ever had a clinical breast exam? Appendix H
Q141: How long has it been since your last breast exam?
46
Pap Tests
Appendix H
Nearly all females have had a Pap test in 2010 and nearly half had one in the
past year. Almost all had their last Pap test as part of a routine visit.
Pap Test
Ever Had a Pap Test
Over Time
Time Since Last Pap Test
(2010)
Reason for Last Visit
(2010)
Routine Checkup, 94%
Within the
Past Year
98%
96%
1995
(n=195)
96%
1999
(n=209)
97%
From 1 Year
to Less Than
2 Years Ago
From 2 Years
to Less Than
3 Years Ago
2006
(n=510)
2010
(n=537)
From 3 Years
to Less Than
5 Years Ago
49%
Check Current/Previous
Problem, 6%
13%
(n=517)
8%
8%
Base=females
5 or More
Years Ago
22%
(n=509)
Q145: A Pap test is a test for cancer of the cervix. Have you ever had a Pap test?
Q147: How long has it been since you had your last Pap test?
Q149: Ws your last Pap test done as part of a routine checkup or to check a current or previous problem?
Appendix H
48
Prostate Exams
Appendix H
Nearly two-thirds of men have had a prostate exam and the majority have had
one in the past year.
Clinical Prostate Examination
Ever Had a Clinical Prostate Exam
Over Time
Time Since Last Prostate Exam
(2010)
61%
1995
(n=210)
61%
1999
(n=187)
66%
2006
(n=327)
59%
From 1 Year to Less
Than 2 Years Ago
11%
Than 3 Years Ago
11%
65%
2010
(n=272)
Than 5 Years Ago
7%
Base=males
5 or More Years Ago
13%
(n=174)
Q151: A clinical prostate exam is when a health professional feels the prostate for lumps. Have you ever had a prostate exam?
Q152: How long has it been since your last prostate exam?
Appendix H
50
Testicular Exams
Appendix H
Seven in ten men have had a testicular exam, up from previous years. Half
have had one in the past year.
Testicular Examination
Ever Had a Testicular Exam
Over Time
Time Since Last Testicular Exam
(2010)
60%
60%
63%
71%
From 1 Year to Less
Than 2 Years Ago
Than 3 Years Ago
1995
(n=210)
1999
(n=187)
2006
(n=317)
2010
(n=270)
Than 5 Years Ago
50%
14%
9%
10%
Base=males
5 or More Years Ago
17%
(n=190)
Q153: A testicular exam is when a health professional checks the testicles for signs of cancer. Have you ever had a testicular exam?
Q154: How long has it been since your last testicular exam?
Appendix H
52
Access to Health Care
Appendix H
Health Care Coverage
Appendix H
Although nearly nine in ten (88%) residents have health coverage, this
number has dropped 7% from 1995 and 5% from 2006.
Health Care Coverage Over Time
95%
92%
93%
89%
5%
8%
7%
11%
1995
(n=406)
1999
(n=405)
2006
(n=864)
2010
(n=807)
Yes, have health coverage
No health coverage
Appendix H
Q29: Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs (Health Maintenance Organizations), or government plans such as Medicare?
55
Selection and Location of
Medical Care
Appendix H
Transportation and Caregivers
Appendix H
Nearly everyone has their own transportation in Ionia County. One in five are
caregivers for a family member.
Transportation and Caregivers
Are a Primary Care Giver
for a Family Member
Over Time
Have Own Transportation
Over Time
96%
4%
2006
(n=850)
22%
20%
78%
80%
2006
(n=847)
2010
(n=805)
95%
5%
2010
(n=810)
Yes
No
Q167: Do you have your own transportation?
Q169: Are you a primary care giver for a family member?
Appendix H
58
Community Perceptions
Appendix H
Most Important Community Problem
Appendix H
Ionia County residents cite jobs as the most important community problem by
far, and has remained a top concern since 2006. Drugs and alcohol have
been perceived as major community problems since the mid-1990s.
Most Important Problem in Community Today
Most Important Community Problem
in 2010
Jobs
44%
Drugs and Alcohol
12%
Health Care
10%
Education
8%
Property Taxes
7%
Help for the Needy
5%
Streets (physical)
4%
Crime (including gangs)
1995
(n=406)
1999
(n=417)
2006
(n=866 )
2010
(n=810)
Drugs/Alcohol
(21%)
Drugs/Alcohol
(19%)
Jobs
(31%)
Jobs
(44%)
Education
(17%)
Education
(15%)
Drugs/Alcohol
(13%)
Drugs/Alcohol
(12%)
Jobs
(9%)
Health Care
(10%)
Health Care
(11%)
Health Care
(10%)
Crime
(8%)
Crime
(9%)
Property Taxes
(7%)
Education
(8%)
Health Care
(8%)
Help for the
Needy
(7%)
Education
(7%)
Property Taxes
(7%)
2%
Environment 1%
(n=810)
Top 5 Most Important Community Problems
Over Time
Other
4%
Don’t Know
4%
Appendix H
Q25: What do you feel is the most important problem in your community today?
61
Most Important Community
Health Problem
Appendix H
Cancer has been consistently cited as the number one community health problem
over the past 15 years. More recently, obesity and lack of health insurance have
come to be viewed as major health-related problems in Ionia County.
Most Important Health Problem in Community Today
Most Important Community Health Problem
in 2010
Top 5 Most Important Community Health
Problems Over Time
19%
Cancer
Obesity
13%
1995
(n=406)
1999
(n=417)
2006
(n=866)
2010
(n=810)
Lack of Health
Insurance
13%
Cancer
(10%)
Cancer
(21%)
Cancer
(27%)
Cancer
(19%)
Alcoholism
(2%)
Drug Abuse
(3%)
Obesity
(12%)
Obesity
(13%)
HIV/AIDS
(1%)
Lack of Health
Insurance
(3%)
Lack of Health
Insurance
(12%)
Lack of Health
Insurance
(13%)
Allergies
(1%)
AIDS
(3%)
Drug Abuse
(7%)
Drug Abuse
(7%)
Heart Problems
(<1%)
Smoking/
tobacco use
(3%)
Smoking/
tobacco use
(4%)
Specific
Diseases
(3%)
Drug Abuse
Diseases (Diabetes, MS,
dementia)
7%
3%
Heart Disease
2%
Smoking/tobacco use
2%
Youth high risk behavior
2%
Lack of overall access
to healthcare
2%
Harm caused by environmental damage
2%
Other
Don’t Know
(n=810)
10%
27%
Appendix H
Q27: What do you feel is the most important HEALTH problem in your community today?
63
Health Department Services
Appendix H
When Ionia County residents think of their local health department, immunizations come first
to mind. Other services for which the ICHD is known are the WIC program, family planning,
prenatal services, mental health/substance abuse counseling, and health screenings.
Services Identified By Local Health Departments
Services Identified By Local
Health Department (2010)
33%
Immunizations
WIC
13%
Family Planning
9%
Mental Health/Substance
Abuse Counseling
5%
Prenatal Services
4%
Well Water Safety Issues
4%
Health Screening (e.g.,
cancer, cholesterol)
Disease Prevention
Education Classes
1995
(n=298)
1999
(n=279)
2006
(n=550)
2010
(n=407)
Immunizations
(58%)
Immunizations
(64%)
Immunizations
(50%)
Immunizations
(65%)
Family
Planning
(7%)
WIC
(7%)
WIC
(11%)
WIC
(18%)
WIC
(5%)
Prenatal
Services
(5%)
Health
Screenings
(9%)
Family
Planning
(13%)
Well Water
Safety
(4%)
Family
Planning
(5%)
Family
Planning
(9%)
Mental Health/
Substance
Abuse
Counseling
(8%)
Prenatal
Services
(4%)
Health
Screenings
(3%)
Prenatal
Services
(6%)
Prenatal
Services
(6%)
4%
4%
Well-Baby Services
3%
General Health/
Medical Services
3%
Septic Systems Inspection
2%
Restaurant Inspections
2%
Environmental Issues
Top 5 Services Identified By Local Health Departments
Over Time*
(n=810)
2%
Note: responses less than 2% not shown
*Since proportions in 1995 and 1999 excluded those who said “don’t know,” proportions in this table for
2006 and 2010 were recomputed on the lesser base, removing those who said “don’t know.”
Appendix H
Q181: There is a local health department in every county in Michigan that provides a number of services. Please name a service provided by your local health department.
65
Services Received From
County Agencies
Appendix H
The majority (54%) of Ionia County residents have not utilized any area
agencies or their services. The agency used most often is the County Health
Department, followed by the Department of Human Services.
Ionia County Agencies Used
Top 5 Agencies Used
Over Time
Agencies Used
(2010)
Ionia County Health
Department
20%
Department of Human
Services (FIA)
Ionia County Community
Mental Health
Ionia County Commission
on Aging
11%
6%
6%
Planned Parenthood/
Family Planning
2%
Ionia Area Hospice
2%
Other
None
2006
(n=886)
2010
(n=810)
ICHD
(17%)
ICHD
(20%)
DHS
(6%)
DHS
(11%)
ICCA
(6%)
ICCMH
(6%)
ICCMH
(4%)
ICCA
(6%)
Ionia Area
Hospice
(2%)
Family
Planning
(2%)
7%
(n=811)
54%
Appendix H
Q183: What agencies within Ionia County have you received services from?
67
Reasons For Service Non-Use and
Services Desired
Appendix H
Half of Ionia County residents report they don’t need services. However, most of those
who could use services cannot think of a reason why they don’t use them. Among issues
cited as deterrents are cost, lack of awareness, poor reputation, transportation, and pride.
Reasons for Not Using Ionia County Services in 2010
No Need for Services
49%
Cost
2%
Not Aware of Services
2%
Poor Reputation
2%
Do Not Qualify
2%
Visit Personal Physician
2%
Transportation 1%
Too Proud 1%
Don’t Know Where to Go/Who to Ask 1%
Too Far/Inconvenient/Hard to Find 1%
Don’t Know/Not Sure/Nothing
40%
(n=811)
Appendix H
Q185: What has deterred you from seeking services within the county?
69
The vast majority (72%) of Ionia County residents did not volunteer a desired
county service. Affordable health care was cited most often and most of the
other mentions include services that already exist.
Services Desired in Ionia County in 2010
Desired Services
(Based on Total Sample)
Affordable Healthcare/
Free Clinic
Help for the Needy
Desired Services
(Based on Valid Responses)
Affordable Healthcare/
Free Clinic
10%
6%
37%
Help for the Needy
22%
Abuse Treatment and
Counseling Services
2%
Abuse Treatment and
Counseling Services
8%
More/Better Doctors and
Hospitals
2%
More/Better Doctors and
Hospitals
7%
Public Transportation
2%
Public Transportation
7%
Youth Services
6%
Youth Services
Recycling/Affordable Trash
Pickup
More Information on
Existing County Services
Other
2%
1%
Recycling/Affordable Trash
Pickup
1%
More Information on
Existing County Services
2%
No response
72%
Other
4%
2%
7%
(n=810)
Appendix H
Q187: What services, if any, would you like to see offered within the county?
70
Sexual Practices and Attitudes
Related to HIV/AIDS
Appendix H
Perception of Personal Risk
for HIV/AIDS
Appendix H
Over the past 15 years, Ionia County residents have become increasingly more
confident that their risk of contracting HIV is low. In 2010, nearly eight in ten (79%)
report they have no chance of contracting the virus and this remains largely unchanged
over the past year.
Risk of HIV Infection
Perceived Chance of Contracting
HIV/AIDS Virus
59%
64%
Chances of Contracting HIV/AIDS in Past
Year
8%
5%
4%
5%
87%
89%
93%
94%
5%
6%
3%
72%
79%
None
Low
Medium
High
35%
31%
25%
18%
5%
4%
3%
2%
1995
(n=394)
1999
(n=407)
2006
(n=849)
2010
(n=801)
1995
(n=406)
Q189: What are your chances of getting the HIV/AIDS virus? Would you say…?
Q191: In the past year, have your chances of getting the HIV/AIDS virus increased, decreased, or stayed the same?
1999
(n=402)
2006
(n=842)
Decreased
Stayed the same
Increased
1%
2010
(n=789)
Appendix H
73
Sexual Behavior
Appendix H
The number of people being tested for HIV/AIDS has increased notably since
1995, with 53% reporting in 2010 that they have been tested. The majority of
Ionia County residents had one sexual partner over the past year.
HIV/AIDS Tests and Number of Sexual Partners
Had an HIV/AIDS Test in the Past
Over Time
(% Yes)
Number of Sexual Partners in Past Year
Over Time
4%
34%
1995
(n=388)
46%
47%
1999
(n=383)
2006
(n=834)
53%
2 or More
1
None
2010
(n=778)
75%
21%
2006
(n=835)
MEAN = .95
Q193: Have you ever been tested for HIV/AIDS? Include blood donations after 1985, and include saliva tests.
Q195: How many sex partners did you have in the past year?
4%
69%
28%
2010
(n=787)
MEAN = .88
Appendix H
75
Most people never use a condom, but then again, most have only one sexual
partner. People with two or more partners are significantly more likely to use
a condom than people with only one partner.
Condom Use During Sexual Intercourse
Frequency of Condom Use
by Marital Status and
Number of Sexual Partners
(2010)
Frequency of Condom Use
Over Time
8%
2%
1%
2%
6%
Number of Sexual
Partners in Past Year
2%
2%
C.
One
(n=526)
E.
Two or More
(n=28)*
Always
4%
50%
Most of the time
1%
18%
Some of the time
2%
0%
Rarely
3%
14%
Never
90%
18%
4%
87%
86%
2006
(n=849)
2010
(n=557)
Always
Most of the time
Some of the time
Rarely
Never
Appendix H
Q197: How often do you (or your partner) use a condom during sexual intercourse?.
76
On average, Ionia County residents are almost 18 years old when they have their first
sexual experience. Those who are victims of sexual assault have their first sexual
experience two years earlier than those who aren’t victims. Nearly one in five (18%)
are victims of sexual assault.
Age of First Sexual Experience and Sexual Assault
Victim of Sexual Assault
(2010)
Age at First Sexual Experience
Over Time
(Mean)
No, 82%
17.8
17.7
2006
(n=733)
2010
(n=722)
Yes, 18%
Age at First Sexual Experience (Mean)
A. Experienced Sexual Assault = 16.1
B. No Sexual Assault = 18.1
Q199: How old were you when you had your first sexual experience?
Q201: Have you ever been the victim of a sexual assault?
Appendix H
77
Attitudes Concerning HIV/AIDS
Appendix H
Ionia County residents are fairly tolerant of those diagnosed with HIV/AIDS.
Additionally, they are more likely to encourage teenagers to use condoms
today than they were fifteen years ago.
Attitudes About HIV/AIDS
Willing to Work Next to/Near Someone
with HIV/AIDS
Over Time
(%Yes)
78%
1995
(n=404)
85%
1999
(n=408)
79%
2006
(n=847)
Encourage Teenagers to Use Condoms
Over Time
(%Yes)
87%
74%
2010
(n=728)
Q203: Would you be willing to work next to or near a person who is infected with the HIV/AIDS virus?
Q207: If you had a teenager who was sexually active, would you encourage him or her to use a condom?
1995
(n=395)
78%
1999
(n=399)
85%
89%
2006
(n=831)
2010
(n=775)
Appendix H
79
REPORT 2012
Evaluation of the
Great Start Initiative
Customized Feedback Report
Ionia GSC/GSPC
Prepared by Dr. Pennie Foster-Fishman
and the System exChange Evaluation Team
www.thesystemexchange.org
1
Appendix I
For More Information
Contact:
Pennie Foster-Fishman, Ph.D.
and the System exChange Team
316 Physics Road
Department of Psychology
East Lansing, MI 48824
eciceval@gmail.com
or toll free at 1-866-343-5279
www.thesystemexchange.org
Acknowledgements
This evaluation would not have been possible without the support and
hard work of:






The financial support of the W.K. Kellogg Foundation
Great Start Collaborative Directors and Great Start Parent Coalition Parent
Liaisons
Early Childhood Investment Corporation Staff
GSC/GSPC members
Office of Survey Research, IPPSR
The System exChange Team Members
 Morgan Bolen
 I-Chien Chen
 Monica Fischer
 Sarah Harfst
 Sara Hockin
 Katie Irey
 Kathryn McAlindon
 Jenny Mortensen
 David Reyes-Gastelum
 Kelly Warsinske
 Abby Wattenberg
 Mei You
Appendix I
Great Start Initiative Evaluation
Executive Summary
Ionia GSC/GSPC
2012
The goal of the 2012 Great Start Evaluation was to assess the impact of the Great Start
initiative at the State and Local levels, paying particular attention to gains made since the 2010
evaluation.
Key statewide findings include:
 Compared to 2010, GSCs and GSPCs in 2012 made significantly more progress in
building the systems changes needed to ensure that all children are ready for school.
 On every outcome area examined, GSCs/GSPCs accomplished far more in 2012 than
they did in 2010. Of course GSCs/GSPCs varied in their achievement levels, but in general
the trend across the state is positive movement forward.
 GSCs and GSPCs also significantly strengthened all 8 levers for change and these
levers continue to play an important role in 2012.
 GSCs/GSPCs grew the most between 2010 and 2012 when they built authentic voice,
local readiness for change, and actively pursued systems change.
 Three NEW levers for change have been identified: Local Champions, Root Cause
Focus, and Equity Orientation and these levers were related to accomplishment levels
in 2012.
 GSC and GSPC infrastructure also mattered, particularly the extent to which they
created a continuous learning environment.
 BOTH the GSC and the GSPC continue to matter!
 The gap between older and newer collaboratives has significantly diminished.
This summary report focuses on your GSC/GSPC’s:
1. Accomplishments: Outcomes which show progress toward an improved and expanded
early childhood system.
2. Levers: key change strategies which are directly related to the success of Great Start
efforts.
3. Stage of Promoting Change: level of performance on five core accomplishment areas.
2012 GSC/GSPC Participation - Ionia: 49 surveys were sent out to a list of GSC/GSPC Members
and Community Partners provided by the GSC Director and Parent Liaison. Your GSC Response Rate
was 65% and GSPC Response Rate was 73.3%. Overall, the response rate for members and nonmembers was 67.3%. Statewide, 3106 surveys were sent out, with an overall response rate of 78%.
2
Appendix I
Overview
Ionia
2010
2010 to
2012
Statewide
2012
2012
33.3%
60.0%
47.0%
Increased Access to Early Childhood Services
35.9%
70.0%
55.1%
Increased Coordination and Collaboration
Across Agencies
46.2%
66.7%
63.2%
Expanded Array of Early Childhood Services
32.4%
82.1%
59.3%
Sustained and Expanded Public and Private
Investment in Early Childhood
20.5%
63.3%
41.7%
30.8%
73.3%
60.8%
30.8%
73.3%
53.1%
28.2%
73.3%
46.7%
43.6%
66.7%
50.3%
31.6%
70.0%
43.4%
25.0%
50.0%
44.4%
0.0%
66.7%
22.0%
For Parents in GSC/GSPC
41.7%
63.6%
63.7%
For Organizations in GSC
4.5%
50.0%
39.5%
Accomplishments:
% Respondents reporting that
GSC/GSPC has accomplished these impacts/outcomes
Quite a Bit to a Great Deal
Improved Outcomes for Children and
Families
Improved Early Childhood System
More Responsive Community Context
Comprehensive Early Childhood System
Improvements
Increased Community Support for Early
Childhood Issues
Local Providers More Responsive to Parent
Concerns
More Supportive Local Leaders and Elected
Candidates
Empowered Families as Change Agents
Additional Outcomes:
% respondents reporting
that these conditions exist Quite a Bit to a Great Deal
Parents Needs are Met
Easier Access to Services
Informed Parents
Participation Benefits
3
Appendix I
Building the Levers for Change
The 2010 survey results revealed eight factors critical to promoting Great Start accomplishments. These
are called the “Levers for Change.” Below is your progress in enhancing your GSC/GSPC Levers for
Change. Most numbers reflect the percent of individuals responding “quite a bit” or “a
great deal”. Strong Relational Networks reflects the percent of service referral/access exchanges
happening between GSC member organizations. Active Constituents reflects the average level of
involvement of GSC/GSPC members.
Ionia GSC/GSPC
Authentic
Leadership
and Voice
Readiness for
Systems Change
Change
Climate
Levers for Change
2010
2010
to
2012
2012
Strong Relational Networks
14.8%
43.2%
0.0%
100.0%
45.5%
72.2%
Individuals and organizations believe in the need for change and have the capacity 64.1%
to pursue it.
86.7%
Strong relational networks easily exchange referrals, coordinate services and share
resources across various agencies in the community.
Intentional Systems Change Actions
Active pursuit of system change efforts, such as shifting or adopting new policies,
procedures, or programs to reduce barriers and improve the early childhood system.
Interdependent Organizations
Member organizations see the value in the collaborative effort and support other
partners at the table.
Readiness for Change
Parent Leadership & Voice
Parents are effective leaders and competent champions for early childhood and
represent a knowledgeable, diverse, and visible parent constituency.
42.1%
90.0%
70.6%
90.0%
55.9%
83.3%
59.1%
72.7%
Effective Partnerships
Strong, effective ties between the GSC and GSPC, and also with key outside
organizations in the community.
Engaged
Constituents
Shared Goals
A unified vision shared with the GSC and GSPC, including: an aligned understanding
of, and agreement upon problems, possible solutions, and overall goals.
Active Constituents
Active and involved members making valuable contributions to the GSC/GSPC,
including: speaking at meetings, holding an office, or advocating for early childhood
in the community.
4
Appendix I
Your Great Start Effort: Moving Forward
In addition to seeing how your Great Start Collaborative and Coalition has changed
over time, it is also useful to look at where your GSC/GSPC is in 2012 to identify
strengths and areas that need additional attention.
Ionia GSC/GSPC 2012 Performance
% responding Quite a Bit or a Great Deal
+Strong Relational Networks: % of all possible service delivery access connections
++Active Constituents: Average level of involvement of GSC/GSPC members
Use this diagram to see how
you’re doing on each lever.
1. Each wedge displays your
performance for a lever in 2012.
2. The colored portion of each
wedge (and the number)
represent the extent to which
stakeholders report that your
GSC/GSPC has this component.
3. Identify your strengths,
successes, and opportunities for
growth. Use this
information to plan your
next steps!
Active
Constituents++
Root Cause
Focus
(New!)
Moving Forward:
Your 2012 Highlights
Your Strongest Areas:
Effective
Partnerships
Strong Relational
Networks+
Parent
Leadership & Voice
Intentional Systems
Change Actions
Local
Champions
(New!)
87%
Readiness for
Change
Interdependent
Organizations

Intentional Systems Change
Actions


Effective Partnerships
Parent Leadership and Voice
Areas to Target for
Improvement:
 Strong Relational Networks

Interdependent
Organizations

Active Constituents
5
Appendix I
Based on the 2012 evaluation, the Ionia GSC/GSPC had the characteristics of a Group C GSC/GSPC.
In 2010, Ionia was a Stage 2 GSC/GSPC.
6
Appendix I
About the Great Start Evaluation
The primary goal of the Great Start Evaluation Project is to assess the impact of the Great Start
initiative at the local and state levels. As part of this evaluation, the Great Start survey was
distributed in 2010 and 2012 to members of the Great Start Parent Coalitions (GSPCs), the
Great Start Collaboratives (GSCs) and other key stakeholders within their communities in order
to learn more about local Great Start initiative efforts. Overall, this survey aimed to:




Identify Great Start accomplishments to date and changes in accomplishments over
time.
Understand the GSPC and GSC characteristics related to local success.
Understand what propels the GSCs/GSPCs forward toward greater accomplishments.
Identify lessons learned and recommendations for next steps.
The Executive Summary provides a brief overview of key findings. The full 2012 customized
report contains more detailed information related to the above.
About the Survey Process
Sample: Great Start Directors and Parent Liaisons provided names and contact information
for: GSC members, GSPC members, GSC committee members, and key outside stakeholders not
yet engaged in the Great Start initiative. In 2010, a total of 3205 individuals were identified to
receive the survey. In 2012, a total of 3106 individuals were identified to receive the survey.
Data Collection Procedures: Between May and August 2010 and May and August 2012,
identified participants were invited to participate in an online survey customized for their
GSC/GSPC and their role on their respective GSC/GSPC. A mail survey version was also
available.
Overall Response Rates: In 2010, 2137 usable surveys were received; in 2012, 2194 usable
surveys were received. In both years, some of the surveys returned could not be used (211 in
2010; 228 in 2012). Below is a table summarizing how the sample is distributed across the
different survey versions in 2010 and 2012. The total response rate for 2010 was 73% (77%
among GSCs and 77% among GSPCs); for 2012 it was 78% (85% among GSCs and 75% among
GSPCs).
1
Appendix J
Accomplishments
Data was collected on each of the Great Start initiative’s outcomes, impacts, and goals for the
Great Start initiative. We refer to these as Accomplishments throughout this report. Data on
accomplishments was provided by GSC/GSPC members and outside community partners who
assessed the extent to which the GSC/GSPC efforts that improved these conditions. The Great
Start accomplishments that were measured include:

Improved Outcomes for Children and Families: Outcomes for children and
families are improving, specifically school readiness.
Improved Early Childhood System




Increased Access to Early Childhood Services: Access to early childhood services,
including parents’ awareness of services, is improving.
Increased Coordination and Collaboration Across Agencies: Organizations are
working together efficiently, trusting each other, and being knowledgeable of one
another.
Expanded Array of Early Childhood Services: New or expanded programs and
services for young children and their families are available.
Sustained and Expanded Public and Private Investment in Early Childhood:
Investment in early childhood is increasing in the community.
More Responsive Community Context





Comprehensive Early Childhood System Improvements: Service quality,
workforce skills, and knowledge of the early childhood field are increasing.
Increased Community Support for Early Childhood Issues: Public and leader
support and awareness surrounding early childhood development and service delivery
issues is increasing.
Local Providers More Responsive to Parent Concerns: Organizations are more
responsive to the needs and input of families in the community.
More Supportive Local Leaders and Elected Candidates: City, county, and state
elected officials are more supportive of early childhood issues.
Empowered Families as Change Agents: Parents are more active in early
childhood system building and effective at getting their voices heard.
Additional Outcomes
Parents’ Needs are Met


Easier Access to Services: Parents reported the extent to which there are highquality, easy to access services that meet the needs of families in the community.
Informed Parents: Parents reported the extent to which families are able to find
readily-available and relevant information regarding services in the community.
2
Appendix J
Participation Benefits


For Parents in GSC/GSPC: Parent members assessed their involvement in the
GSC/GSPC and the degree to which it has increased parenting skills, knowledge,
engagement, and use of personal voice.
For Organizations in the GSC: GSC service providers reported on the degree to
which their involvement in the GSC has expanded partnerships, increased
understanding, improved inter-organizational relationships, and increased effectiveness.
Levers for Change
Levers for change refer to those actions and efforts pursued by the GSCs/GSPCs to achieve their
targeted outcomes and goals. Respondents were asked to describe the levers for change
strategies being pursued in their community. Specific respondents were asked to describe
different aspects of the Great Start effort from their perspective. The levers for change that
were assessed included:
Engaged Constituents


Active Constituents: GSC and GSPC members described their level of
involvement/participation in their local GSC/GSPC.
Shared Goals: GSC and GSPC members reported the extent to which they believe their
group has a shared vision and agreement on what needs to happen within the
community.
Parent Leadership and Voice


Effective Partnerships: GSC members reported on the quality of the GSC’s
partnership with the GSPC and with key outside organizations and individuals.
Parent Leadership and Voice: All respondents reported on the extent to which
parents are recognized as leaders and impact the GSC/GSPC and community.
Readiness for Change



Readiness for Change: All respondents reported the extent to which they believe that
the changes promoted by the Great Start Effort are desirable, necessary, and feasible
within their community.
Interdependent Organizations: GSC representatives reported the extent to which
their organizations are committed to the GSC, rely on other GSC organizations, and are
respected by other organizations at the table.
Local Champions: All respondents reported on the extent to which they have created a
sense of urgency for the work within their community, have local business and
government sectors committed to the Great Start effort and have local organizations
aligning their organizations’ plans with the Great Start effort.
3
Appendix J
Systems Change Climate


Intentional Systems Change Actions: GSC Directors reported on the breadth and
depth of current systems change activities.
Strong Relational Networks: GSC organizational representatives described their
actual exchanges of referrals, information, and resources with other GSC service
providing organizations.
Equitable System Pursuits


Root Cause Focus: GSC and GSPC members reported on their GSC/GSPC efforts to
understand and address the root or primary causes of children not being ready for school
in the community.
Equity Orientation: GSC and GSPC members reported on their GSC/GSPC efforts to
ensure that children and families with the highest needs in the community gain access to
quality programs and supports.
4
Appendix J
Executive Summary – Reflection Questions
Please consider these questions prior to the quarterly meetings at the end of February.
What data points seem most relevant to your annual work plan?
Considering your findings, what makes you most proud?
What data in your findings surprised you?
As you look at your survey results… what should your GSC focus on in the future?
As you look at your survey results… what should your GSPC focus on in the future?
Appendix K
Ionia County Great Start
Collaborative Strategic Planning
Reviewing trends from new information & data
Setting Priorities for Goals & Strategies
Appendix L
Updated Data Highlights
 Census Data: fewer children in county population, but more
(higher percentage) of children are in poverty, and/or
receiving a public assistance benefit indicating trouble
meeting economic basic needs. (More on SNAP, TANF, MA/MI
child; free or reduce cost lunch in school)
 TANF- Because of the high percentage of TANF families in
Ionia, when TANF time limits on benefits were added by DHS
and the state legislature in 2012 it had a big impact in Ionia.
MLPP data ranks Ionia County with the highest percentage
drop in FIP cases from 2nd 2011 to 2nd quarter 2012 of all
Michigan counties (with a 48% percent drop)
Appendix L
Updated Data Highlights & Trends –
from GSC 2012 Annual Report
 County has seen a decrease in teen parent population for
first time in many years – with repeat teen births down by
4%
 County seeing a dramatic increase in number of children
ages 0-5 where there is substantiated child abuse and
neglect. Up from 18.25%to 25.6% in most recent reported
years, and above state average of 13.8%
 2.8% Increase in mothers without or only late prenatal care
 Percentage of WIC children reported overweight or “at
risk” of being overweight is down from 2011
Appendix L
Updated Health Indicator Data
Health Indicators
MI
Percentage without Health
Insurance
13.9%
14.9%
75.0%
Immunization rates (age 15-35
months)
Obesity in children
Ionia
81.0%
11.4%
15.4%
Appendix L
from Kindergarten Round up
Families Needed Help with Basic Needs - Kindergarten
Round up Survey
53%
42%
39%
37%
33%
22%
Ionia ISD
Belding
Ionia
Lakewood
Portland
Sarnac
Appendix L
from EIGHTCap Inc. Head Start
Kinds of Basic Needs Help Needed by Head Start Families
at EightCAP
45%
40%
40%
35%
30%
25%
25%
19%
20%
15%
10%
5%
6%
4%
0%
Appendix L
Were homeless
Used Food
Bank/Pantry
Were without heat
Received Shut-off
from Utility
Used Emergency
Room
from Spend a Buck (Priority Setting)
Child hood obesity
prevention activites
16.7%
Collaboration
between EC service
providers
8.1%
Increase preschool
opportunities
38.1%
Parent Leadership
opportunity
18.1%
Basic Needs Support
for 0-5 families
19.1%
Appendix L
Café Conversation TrendsWhat struck participants as important
Categories for "Do Better On"
Make System changes
13.3%
Early Childhood Programming
36.7%
Connections/Linkages
13.3%
Health
23.3%
Social/emotional
6.7%
Economic
6.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Appendix L
Biggest Challenges
Lack of knowing resources…
26.3%
Obesity
18.4%
Budget cuts
18.4%
Poverty growing
13.2%
Lack of jobs
10.5%
Abuse & Neglect
10.5%
Bullying
2.6%
0.0%
5.0%
Appendix L
10.0% 15.0% 20.0% 25.0% 30.0%
Key Factors for Improving School Readiness
34.6%
Parents ready
23.1%
More preschool available
23.1%
Healthy children
19.2%
More economic supports
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Appendix L
2012 Evaluation on Goal Progress by
membership survey
Strongest Areas
 Intentional Systems Change Actions
 Effective Partnership
 Parent Leadership
Areas to Target Improvement
 Strong Relational Networks
 Interdependent Organizations
 Active Constituents
Appendix L
Current Goals in Strategic Plan
 6 Goals:
 Establish and maintain the infrastructure of the ICGS
Collaborative
 Birth to five children and their families are physically
healthy
 Birth to five children and their families are socially and
emotionally healthy
 Families support and guide the learning of their children
ages birth to five
 Children in Ionia County are prepared to succeed in school
 Families of birth to five children are safe and economically
stable
Appendix L
For each Goal’s set of Strategies
 What do you think is no longer a priority?
 What needs to be modified?
 Of the remaining list – what is the top priority
strategy
Appendix L
Goal 1–Establish & Maintain the Great
Start Infrastructure
1. Ensure diversity in Board membership
2. Improve engagement & effectiveness of ICGSC Board
3. Continue to support parent engagement in Board and
in activities
4. Educate parents, faith based organizations and
policymakers on ICGSC mission and vision
5. Increase blended funding opportunities
6. Develop coordinated message and brand
7. Coordinate advocacy messaging in Ionia County
Appendix L
Goal 2: Birth to 5 year old children
and families are physically healthy
1. Improve public awareness on importance of
breastfeeding and increase support
2. Help reduce childhood obesity through nutrition and
physical activity for children and families
3. Improve oral health for young children
4. Reduce smoking during pregnancy
5. Have easy local access to prenatal care
6. Maintain immunization rates for 0-5 children
7. Have social/emotional health supports through
primary care for 0-5 parents
Appendix L
Goal 3: Birth to age 5 children and
families are socially and emotionally
healthy
1. Enhance support for early childhood providers
regarding social emotional health interventions for
0-5 children
2. Enhance supports for families regarding social
emotional health interventions
3. Increase the availability of mental health services for
families with children age 0-5
4. Maintain home visiting support for families with
children age 0-5
Appendix L
Goal 4: Families support and guide
the learning of their children
 Expand the number of family support opportunities
 Increase opportunities for free or low cost options for
families to meet basic needs
Appendix L
Goal 5: Children in Ionia County are
prepared to succeed in school
1. Promote quality preschool experiences in county
2. Increase number of low cost or free quality preschool
opportunities available to all children
3. Have universal preschool opportunities in county
4. Increase training opportunities for child care providers
5. Identify and promote common messaging on brain
development and literacy readiness connections
6. Increase the number of early childhood programs with
quality care for age 0-5
7. Increase preschool economic investment awareness
Appendix L
Goal 6: Families with children age 0-5
are safe and economically stable
1. Increase community awareness of early childhood
programs and resources
2. Increase awareness and use by community partners
of family friendly practices
3. Increase the knowledge and awareness by families
to increase access to programs and services
4. Strengthen collaboration between referral sources
5. Support early childhood service provider
collaboration
Appendix L
ionia
Background Information (All data are for 2010 unless otherwise noted.)
Number
Family Support Programs
Children receiving...
• subsidized child care, ages 0–121 • FIP cash assistance1,3
• Food Assistance Program1,4
Children with support owed
• receiving none (% of those owed) • receiving less than 70% of amount Rate
MI
Percent of children, ages 0-18, receiving assistance
45
246
445
4,393
2.3%
2.8%
27.3%
3.4%
6.2%
30.4%
3,939
756
2,106
23.2%
19.2%
53.5%
20.7%
29.5%
62.6%
Percent of Children
Medicaid
30
FAP
Subsidized
Care
15
0
FIP
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: Michigan Department of Human Services and Michigan Department
of Community Health, Vital Records and Health Data Development
Section.
Number
Rate
MI
Access to Health Care
%
2000
2010change
Population
Child population
0–17
• Ages 0-4
• Ages 5-9
• Ages 10-14
• Ages 15-19
16,569
4,226
4,554
4,838
4,939
15,675
4,098
4,324
4,409
4,544
-5.4%
-3.0%
-5.1%
-8.9%
-8.0%
Children insured
Children, ages 0–18 insured by...
• Medicaid1
• MIChild
Fully immunized toddlers, ages 19–35 months (for the series 4:3:1:3:3:1)1
Lead poisoning in children, ages 1–2
• tested
• poisoned (% of tested)
Children, ages 1–14, hospitalized for asthma (rate per 10,000)2
14,976 94.9% 94.9%
6,307 39.2% 40.7%
214 1.3%
1.2%
944 77.8% 70.0%
658 40.5% 36.2%
4 *
0.8%
14 12.1
20.8
46 5.4% 6.6%
2,112 19.6% 14.4%
207 13.6
19.2
CHILDREN WITH SPECIAL NEEDS
Babies with a birth defect**
Students in Special Education1
Children receiving Supplemental Security Income (rate per 1,000)1
1As of December 2010.
2Annual rate and number are based on the three-year
period 2007–2009 and only for counties with a total
number over 20.
3Family Independence Program.
4State name for the federal Supplemental Nutrition
Assistance Program, formerly called “food stamps.”
KIDS COUNT IN MICHIGAN DATA BOOK 2011
Note: Percentages reflect percent of population unless
otherwise noted.
* Sometimes a rate could not be calculated because of low
incidence of events or unavailable data.
** Based on three year period 2006-2008.
N/A not available.
See Data Notes and Definitions for details.
Appendix M
ionia
Trends in Child Well-Being 2000–2008/09**
BASE YEAR
Economic Security**
Children in poverty
• ages 0–17
• ages 5–17
Students receiving free/reduced
price school lunches2
2005
Abuse/Neglect (per 1,000)
Children in investigated families
Confirmed victims
Children in out-of-home care
Education (not proficient in math)
Fourth grade (MEAP)
Eighth grade (MEAP)
High school students (MME)
Rank1
MI Rate
-100
PerCent change in rate
0
Worse
2009
100
Better
Ionia
Michigan
2,058 13.4%
1,330 11.8%
2006
3,068 20.7%
2,053 19.0%
2010
29
32
22.2%
20.2%
3,302 28.4%
5,117
28
46.5%
Child Health
1998–2000
Less than adequate prenatal care (2008–09)
‡
— —
Low-birthweight babies
49 5.9%
Infant mortality (per 1,000)
5 5.6
3 25.7
Child deaths, ages 1–14 (per 100,000)
Adolescence
Births to teens, ages 15–19 (per 1,000)
Teen deaths (per 100,000)
High school dropouts**
CURRENT YEAR
NumberRate Number Rate
104 46.6
3 61.1
2007
95 10.3%
FY2000
1,297 78.3
152 9.2
64 3.9
2003
268 33.7%
428 49.5%
2008
427 52.3%
47.6%
2007–2009
267 33.4%
53
52
6.4% 15 of 81
3
3.3
2 of 49
2 17.2
16 of 34
74 37.2
52
2 44.1
8 of 39
2010
76
8.8% 41 of 80
FY2010
1,631 107.2
389 25.6
70
4.6
2010
58
7.9%
165 21.0%
2010
363 46.1%
63
66
35 of 76
49
50
55
61
68
29.5%
8.5%
7.6
17.4
10
41
33
33.3
55.6
20
28
11.1%
70.1
13.8
5.1
14
37
178
19
2010
8.5%
22.0%
29
49.6%
A ranking of 1 means a county has the ‘‘best’’ rate compared to other counties in the state. Unless noted, the ranking is based on 82–83 counties.
2
Family income for eligible students is below 185 percent poverty level.
* Sometimes a rate could not be calculated because of low incidence of events or unavailable data.
**Due to changes in the data measures, comparisons between 2000 and the current year could not be made for some indicators.
‡ Due to Michigan’s revised birth certificate, 2008–09 data cannot be compared with those of previous years.
MME – Michigan Merit Exam instead of the MEAP.
Beginning in 2007 Michigan high school students have taken the ACT college entrance exam.
1
77
58
12
Missing bars indicate no change
or a rate could not be calculated;
a ‘‘0’’ reflects no change.
Percentage change is calculated
with unrounded rates.
Total Population
2009
63,905
Unemployment
Rate
Live Births
758
12.6%
Median
Household
Income
$46,926
Appendix M
KIDS COUNT IN MICHIGAN DATA BOOK 2011
63
Kindergarten Round-up
Survey Results
2012
www.GreatStartIoniaCounty.org
Appendix N
The Parent Coalition of the Ionia County Great Start Collaborative (ICGSC) conducted a survey with
parents attending kindergarten screening activities in all of the local school districts. The purpose was to
identify strengths and concerns in the areas of heath, early care and education, social-emotional
development, basic physical needs and family support. The following are the results from the 2012
kindergarten screening. Parents completed a 28 item questionnaire as part of their kindergarten screening
process. Within Ionia ISD, there were 955 children eligible for kindergarten, of those 511 parents or 53.5%
completed the survey.
Some type of preschool experience
Early Care and Education:
Childcare due to unemployment numbers continue to
decline slightly, In 2012, sixty percent of children are
reported to be in childcare at some point during their first
5 years of life due to parent employment. Families
reported overwhelming satisfaction with their childcare
arrangements. Preschool experiences are back on the rise
from previous years. In 2012, 82% of children attended
some type of preschool program. Approximately 48%
were served via a government sponsored program such as
Head Start (HS), Great Start Readiness Program (GSRP),
and Early Childhood Special Education (ECSE).
Childcare Due to Employment
Health:
In 2012, within the county, 96% of children have
some type of health insurance. Approximately 42%
have government sponsored insurance and only 1%
does not have a doctor. This is good news for our
community as this number is declining. Only 13% of
entering kindergarteners have never been to a dentist.
In 10% of homes, there is at least one person who
smokes. Of the respondents, 13% reported that their
child takes some kind of prescription drug.
Twelve percent reported yes, they thought their child would
need extra help with learning. Forty-five percent of families
indicated that their child was enrolled in the Dolly Parton
Imagination Library (DPIL). Enrollment continues to rise.
No Health Insurance
Enrolled in the DPIL program
Reports of children having no health insurance
continues to decline.
2
Appendix N
Social Emotional:
There were several questions designed to gather information regarding children’s social emotional
well-being. The behaviors most frequently identified as being of concern were, children get nervous
easily and children are more active than other children their age. This is consistent with previous
years surveys.
More Active than Other Children
Child Gets Nervous Easily
Basic Needs:
Providing basic needs continues to be an area of
concern for many families in the community. In
2012, 37% of respondents indicated that they
have accessed a community support to help
provide basic needs for their family. In addition, 17%, approximately 90 households, have
at least one member that is on unemployment or
is unemployed but has exhausted their benefits.
This is lower than previous years.
Someone On Unemployment
Family support:
Ninety-two percent of families in Ionia County
indicated that they are easily able to find information about how to get their children ready for
kindergarten. Approximately 45% of respondents have participated in some type of early
intervention program such as: Early Head Start (EHS), Early On (EO), SHARE (Birth to 3 special
education program), Great Parents, Great Start playgroups (GPGS), library programs, public health
nurses or infant mental health services prior to kindergarten entry. Thirteen percent of respondents
have participated in some type of parenting class or support group. Important data points in this area
have remained consistent.
3
Appendix N
Belding:
A total of 162 children were eligible for kindergarten; 79, or 49% of
parents, completed the survey.
With respect to education levels, 90% of mothers
and 87% of fathers had a high school diploma, GED
or higher. There were 10% of mothers and 13% of
fathers that had some high school but had not
completed high school.
Health:
Forty-nine percent had some type of government
funded insurance. Nineteen percent of respondents
reported that their child takes a prescription
medication.
Four percent of respondents indicated that at least
one person smoked in the home.
A little more than half (56%) of respondents
reported that they needed child care
within the first 5 years of their child’s
life. Only 8% reported that their child
DID NOT have a preschool experience
prior to kindergarten. Of those 8%, the number
one reason was parent’s choice not to enroll.
Eighteen percent of parents reported that
their child would need extra help with learning.
Overall, 26% of children were deferred
from kindergarten for some reason and
enrolled in a developmental kindergarten program. Belding respondents held the highest level of participation
with sixty-six percent of participants reporting DPIL enrollment.
4
Appendix N
Social Emotional:
Basic Needs:
Forty-two percent of respondents
have used a community resource to
assist with providing their children
with basic needs. Sixteen percent
of homes of respondents had at
least one parent that was unemployed.
Family Support:
Fifty-seven percent of the respondents engaged
in at least one outreach program prior to their
child attending a preschool.
Thirteen percent of respondents had visited the
ICGSC website.
Eleven percent had participated in some type
of parent class or support group.
No respondents reported participating in family
counseling opportunities
5
Appendix N
Ionia:
With respect to education levels, 86% of
mothers and 83% of fathers had a high
school diploma, GED or higher. There were
12% of mothers and 9% of fathers that had
some high school but had not completed high
school.
Health:
A total of 98% of children have a doctor and
approximately 64% have some type of
government funded insurance. Fourteen
percent of respondents reported that their
child takes a prescription medication.
Twenty percent of respondents indicated that at least
one person smoked in the home.
A total of 62% of respondents reported
that they needed child care within the first
5 years of their child’s life. In addition, 20%
reported that their child DID NOT have a preschool experience prior to kindergarten. Of those, 40% indicated
it was their choice, 44% reported that they tried to enroll in a program but it was full, and 16% indicated that
they were unable to afford it. In addition, 16% of parents reported that their child would need extra help with
learning. Overall, 23% of children were deferred from kindergarten for some reason and enrolled in a
developmental kindergarten program. Forty-four percent of participants were enrolled in the DPIL.
6
Appendix N
Social Emotional:
Basic Needs:
Over half (53%) of respondents reported that they
have used a community resource to assist with
providing basic needs to their family; 13% of
homes of respondents had at least one parent that
was unemployed.
Family Support:
Forty-three percent of the respondents
engaged in at least one outreach program prior
to their child attending a preschool.
Eleven percent of respondents had visited the
ICGSC website.
Seven percent had participated in some type
of parent class or support group.
7
Appendix N
Lakewood:
A total of 209 children were eligible for kindergarten, 117, or 56%
of parents, completed the survey.
and 93% of fathers had a high school diploma,
GED or higher. There were 4% of mothers and
4% of fathers that had some high school
education but had not completed high school.
Health:
Ninety-nine percent of respondents reported that
their child had a doctor and 33% had some type
of government funded insurance. Twelve
percent of respondents reported that their child
takes a prescription medication.
Eight percent of respondents indicated that at
least one person smoked in the home.
Approximately 51% of respondents reported
that they needed child care within the
first 5 years of their child’s life. Twenty-five
percent reported that their child DID NOT
have a preschool experience prior to
kindergarten. Of those, 69% indicated it was
their choice, 18% tried to enroll but the program
was full and 14% indicated that they were unable
to afford it. In addition, 15% of parents reported
that their child would need extra help with learning.
Overall, 20% of children were enrolled in Kinder-Start (deferred from kindergarten).
Thirty-two percent of participants were enrolled in the DPIL.
8
Appendix N
Social Emotional:
Basic Needs:
Over 30% of respondents reported
that they have accessed community
supports to assist with providing
their family with basic needs.
Seventeen percent of respondents
had at least one parent that was
unemployed.
Family Support:
Forty-seven percent of the respondents
engaged in at least one outreach program
prior to their child attending a preschool.
Eight percent of respondents had visited
the ICGSC website.
Eleven percent had participated in some
type of parenting class or support group.
9
Appendix N
Portland: A total of
214 children were eligible for kindergarten; 144, or 67%
of parents completed the survey.
and 94% of fathers had a high school diploma, GED
or higher. There were 4% of mothers and 4% of
fathers that had some high school education but had
not completed high school.
Health:
Of those reporting, 98% indicated that their child had
a doctor, and 30% had some type of government
funded insurance. Sixteen percent of respondents
medication.
Five percent of respondents indicated that at
Sixty-nine percent of respondents
reported that they needed child care
within the first 5 years of their child’s
life. Approximately 16% reported that
their child DID NOT have a preschool
experience prior to kindergarten. Of
those, 74% indicated it was their choice,
And 26% reported that they tried to enroll
but the program was full. In addition, 6%
of parents reported that their child would need extra help with learning.
Overall, 32% of children were deferred from kindergarten for some reason and enrolled in a
developmental kindergarten program.
Forty-eight percent of participants were enrolled in the DPIL.
10
Appendix N
Social Emotional:
Basic Needs:
Twenty-two percent of respondents
reported that they have accessed a
community service to help provide
basic needs to their family. Nine
percent of homes of respondents had at
least one parent that was unemployed.
Family Support:
Thirty-one percent of respondents
engaged in at least one outreach program
prior to their child attending a preschool.
Fifteen percent of respondents had
visited the ICGSC Website.
Eight percent had participated in some
type of parent class or support group.
11
Appendix N
Saranac:
and 93% of fathers had a high school diploma.
There were 9% of mothers and 7% fathers that
had some high school education but had not
completed high school.
Health:
One hundred percent of children had a doctor and
about 34% had some type of government funded
insurance. Approximately 14% of respondents
medication.
Eleven percent of respondents indicated that at
Approximately 61% of respondents reported
that they needed child care within the first 5
years of their child’s life. Twenty-one percent
reported their child DID NOT have a preschool
experience prior to kindergarten. Of those, 50%
indicated it was their choice, 20% reported they
tried but the program was full and 30% indicated
that they were unable to afford it. In addition,
16% of parents reported that their child would
need extra help with learning.
Overall, 20% of children were deferred from kindergarten
for some reason and enrolled in a developmental kindergarten program.
Thirty-nine percent of participants were enrolled in the DPIL.
12
Appendix N
Social Emotional:
Basic Needs:
Thirty-nine of respondents
reported that they utilized
community resources to help
provide basic needs for their
families; 16% of homes of
respondents had at least one
parent that was unemployed.
Family Support:
Fifty-nine percent of respondents
engaged in at least one outreach
program prior to their child attending
a preschool.
Sixteen percent of respondents had
visited the ICGSC website.
Twenty percent had participated in
some type of parent class or support
group.
13
Appendix N
Kindergarten Screening Parent Survey
The Ionia County Great Start Collaborative (ICGSC) is a group of community members and leaders dedicated to assuring that all children are
provided with a strong foundation so that they enter kindergarten eager, prepared and ready to learn. The group has several committees that
focus on each of the following areas: health, early care and education, social-emotional, basic physical needs, and family support. Information
from last year was complied into the Status on Young Children report. We would greatly appreciate you completing this survey so we can provide current information to the community and direct our attentions to the areas that YOU indicate would be of greatest benefit to you and your
family. Thank you for your time.
DEMOGRAPHIC INFORMATION:
Child’s birth date:
Age:
Person completing form: Mother___ Father___ Other___
Parent’s Education: (check the highest level obtained)
Mother: Some HS___ GED___ HS Graduate___ Tech/trade school___ 2-year degree___ BA/BS___ Masters/+ __
Father: Some HS___ GED___ HS Graduate___ Tech/trade school___ 2-year degree___ BA/BS___
Masters/+ __
Who does the child live with?
Biological parents___ Mother only___
Father only___
Joint Custody (splits time equally)_____
Mother & stepfather___ Mother & significant other___ Father & stepmother___ Father & significant other___
Other extended family members (grandparents, aunts, etc.) ___
HEALTH:
1.
Does your child have a doctor?
2.
Has your child ever been to a dentist?
3.
Currently, does your child have health insurance?
Yes
No
Yes
No
____ None, no insurance
____ Private health insurance
____ Military Health Care
____ Government Sponsored (Medicaid, Molina, MI Child, Health Plan of MI, McLaren, PHP-MM Family Care)
4.
Does anyone currently smoke in the child’s home on a regular basis?
5.
Does your child take any kind of prescribed medications now?
If yes, for what?
Yes
No
Yes
No
EARLY CARE AND EDUCATION:
6.
Did your child need childcare due to your employment anytime during their first 5 years of life?
If yes, were you satisfied with the childcare arrangement that you found?
7.
Did your child attend a formal preschool program as a 4 or 5 year old?
Yes, he/she attended:
____ Head Start
____ Great Start Readiness Program (Jump Start, Ready 4 School, D 4’s etc)
____ Early Childhood Special Education Program
____ A private preschool program __________________________________ (please indicate which one)
Yes
No
Yes
No
Yes
No
No, my child did not attend a preschool program because:
____ It was my choice, as I did not feel he/she needed that experience prior to entering kindergarten.
____ I tried to enroll him/her in ______________________________ (name program) but it was full.
____ I was unable to afford a preschool program for him/her at this time.
8.
Was your child enrolled in the Dolly Parton Imagination Library of Ionia County?
9.
Do you think your child is going to need extra help with learning upon entering kindergarten?
10.
How often do you read to your child?
Less than 1x per week
Yes
1-3x per week
14
(Continued on the back)
Appendix N
No
Daily
SOCIAL EMOTIONAL:
11.
Do you think your child is going to need extra help with their behavior in kindergarten?
Yes
No
12.
Do you think your child has a short attention span compared to other children their age?
Yes
No
13.
Do you think your child is more active than other children his/her age? (i.e. always on the go, can’t sit still)
Yes
No
14.
Do you think your child gets nervous easily?
Yes
No
15.
Does your child get in fights with other children?
Yes
No
16.
Has your child experienced a parent that is depressed?
Yes
No
17.
Has your child witnessed violence in your home?
Yes
No
18.
Has your child seen a family member with a drug or alcohol problem?
Yes
No
BASIC NEEDS:
19.
Yes
No
20.
Have you ever accessed community service (food banks, EightCap, DHS, etc) to provide necessary items for your
family such as food, assistance with bills, housing, etc?
Have you moved from one home to another is the past year?
Yes
No
21.
Currently, is there anyone in your household that has lost their job and/or is on unemployment?
Yes
No
22.
Currently, is there anyone in your household that NO LONGER qualifies for unemployment and is unable to find a
job?
Is there anyone in your household right now that has lost their job in the past year but is now working again for a
significantly lower wage?
Yes
No
Yes
No
23.
FAMILY SUPPORT:
24.
Were you easily able to find information about how to get your child ready for kindergarten?
25.
Did you ever participate in any of these early intervention programs with your child?
____ Home visits by a nurse from the health department, United Lifestyles, or home health agency.
____ Home visits by Early Head Start
____ Home visits by Infant Mental Health specialist from Community Mental Health
____ Home visits by Early On or the birth to three special education staff
____ Parent-child Playgroups thru Great Parents/Great Start and Early On
____ Library story-hour programs
____ (Child/family) Counseling (private or from Community Mental Health)
____ None of the above
Have you ever visited the Great Start Collaborative website (GreatStartIoniaCounty.org)
If yes, have you ever looked at the community calendar for events related to young children?
26.
27.
No
Yes
No
Yes
No
Yes
No
Have you ever attended any type of parenting class or support group?
If yes, please explain:
28.
Yes
Is there anything that would have been helpful to you in getting your child off to a Great Start?
15
Appendix N
16
Appendix N
Appendix O
Appendix O
Prepared for Sparrow Health System Sparrow Ionia Hospital:
Community Health Needs Assessment Prepared by Public Policy Associates, Incorporated February 2013 Appendix P
Public Policy Associates, Incorporated is a public policy research, development, and evaluation firm headquartered in Lansing, Michigan. The firm serves clients nationally in the public, private, and nonprofit sectors by conducting research, analysis, and evaluation that supports informed strategic decision making. 119 Pere Marquette Drive, Suite 1C, Lansing, MI 48912‐1231, (517) 485‐4477, Fax 485‐4488, www.publicpolicy.com Appendix P
Table of Contents Executive Summary ......................................................................................................................1
Sparrow Ionia Hospital Service Area .................................................................................... 1
Key Health Care Needs Within the Sparrow Ionia Hospital Service Area ..................... 1
Priority Health Issues to Be Addressed by Sparrow Ionia Hospital ................................ 2
Introduction ...................................................................................................................................3
Purpose of this Report ............................................................................................................. 3
Data Gathering ......................................................................................................................... 3
Report Content ......................................................................................................................... 4
Sparrow Ionia Hospital Area Profile ..........................................................................................5
Community Health Indicators ..................................................................................................11
Children in Poverty ............................................................................................................... 13
Single Parent Households ..................................................................................................... 14
Housing Costs ........................................................................................................................ 15
Education ................................................................................................................................ 16
Community Safety ................................................................................................................. 17
Environmental Quality .......................................................................................................... 18
Obesity Among Adults ......................................................................................................... 19
Obesity Among Young People ............................................................................................. 20
Tobacco Use Among Adults ................................................................................................. 21
Tobacco Use Among Youth .................................................................................................. 22
Alcohol Use Among Adults ................................................................................................. 23
Alcohol Use Among Adolescents ........................................................................................ 24
Access to Physicians .............................................................................................................. 25
Preventable Hospitalizations ............................................................................................... 26
Medicaid Enrollment ............................................................................................................. 27
Health Insurance Coverage .................................................................................................. 28
Disease Prevention: Immunization ..................................................................................... 29
Mental Health (Adults) ......................................................................................................... 30
Mental Health (Youth) .......................................................................................................... 31
Perceived Health Status ........................................................................................................ 32
Infant Mortality ...................................................................................................................... 33
Low‐Weight Births ................................................................................................................. 34
Premature Deaths................................................................................................................... 35
Appendix P
Cardiovascular Disease ......................................................................................................... 36
Accidental Deaths .................................................................................................................. 37
Community Health Assets .........................................................................................................39
Hospitals .................................................................................................................................. 39
Federally Qualified Health Clinics ...................................................................................... 39
Rural Health Clinics............................................................................................................... 39
Extended Care Facilities ........................................................................................................ 40
Physicians and Nurses .......................................................................................................... 40
Findings ........................................................................................................................................41
Socioeconomic Indicators ..................................................................................................... 41
Health Behaviors .................................................................................................................... 42
Access to Care ......................................................................................................................... 43
Children’s Health ................................................................................................................... 44
Health Outcomes.................................................................................................................... 45
Community Health Issues .........................................................................................................47
Methods ...................................................................................................................... Appendix A Interview and Focus Group Participants............................................................... Appendix B Appendix P
Acknowledgements ____________________ This report was prepared with the assistance of Sparrow Ionia Hospital and residents throughout Ionia County who provided their time and insights in helping to identify the most important health needs, issues, and concerns throughout this region. Included among them are health care consumers, health care professionals, community leaders, government officials, working people, retirees, educators, community organization staff, and others. This assessment would not have been possible without their participation. We would also like to thank Lisa McCafferty, Director and Health Officer for the Ionia County Health Department, and Robert Lathers, CEO, Ionia County Community Mental Health, for their insights and advice for this health needs assessment. Their knowledge and experience as public health officials provided considerable insight regarding the health status and the health needs of the community served by Sparrow Ionia Hospital. Sincerely, William Roeser, CEO Dennis Swan, President and CEO Sparrow Ionia Hospital Sparrow Health System Appendix P
Appendix P
Assessing community health needs and adopting a strategy to address those needs provides hospitals with a valuable opportunity to work together with community partners to identify strategies for improving health, quality of life, and the community’s vitality.1 Robert Wood Johnson Foundation, 2012 1
Robert Wood Johnson Foundation, “What’s new with community benefit?” Issue Brief (October 2012),
1. http://www.rwjf.org/healthpolicy.
Appendix P
Appendix P
Executive Summary Sparrow Ionia Hospital Service Area Sparrow Ionia Hospital serves patients throughout Ionia County, Michigan. Patients requiring more advanced services than are available at Sparrow Ionia Hospital typically seek these services in Lansing or in Grand Rapids, Michigan. The following information regarding the most important health care needs and issues within Ionia County is based on insights provided by health care consumers, community leaders, health care professionals, and others in the Sparrow Ionia Hospital service area who were interviewed as part of this assessment. These findings are also based on social, economic, and health care data about Ionia County that were drawn from federal and state government agency reports. Much of the quantitative data presented in this assessment were extracted from these sources and provided to Sparrow Health System by the Ingham County Health Department. Key Health Care Needs Within the Sparrow Ionia Hospital Service Area Healthy Life Styles. The Ionia community is characterized by high rates of overweight and obese adults and youth. Interviewees generally recognize a need to reduce obesity in children and adults within the community in order to reduce the likelihood of diabetes and other chronic diseases in the future. This is closely associated with the need to promote healthy lifestyles through better eating patterns, greater amounts of physical activity, and the reduction of “screen time” for video games and television, especially among children, as indicated by individuals who were interviewed for this report. Access to Primary Care Services. According to data provided by the Michigan Department of Community Health, Ionia County is underserved by primary care physicians and other primary care providers. One of seven community residents lacks a primary care physician. Data also show that residents of Ionia County are more likely to lack health insurance than residents elsewhere in the Sparrow Health 1
Sparrow Ionia Hospital | Public Policy Associates, Inc. Appendix
P
System service area, and it is believed by some interviewees that lack of insurance contributes to area residents’ lack of a primary care physician. Chronic Diseases. The impact of poor health behavior choices and the lower rate of health insurance among Ionia County households contribute towards relatively high rates of chronic diseases in the area, according to community leaders who participated in this assessment. It is widely accepted among health care professionals that high rates of obesity and depression or poor mental health are associated with chronic diseases, and these diseases (such as heart disease or diabetes) are typically reflected in relatively high levels of premature mortality (e.g., death before age 75). Lack of access to primary care services may also contribute to the lack of preventive care and ongoing monitoring that is needed to keep chronic diseases in check. Priority Health Issues to Be Addressed by Sparrow Ionia Hospital Based on the needs identified in the Healthy! Capital Counties collaborative and supplemental research conducted by Sparrow Health System, Sparrow Ionia Hospital will address the following priority health issues in an Implementation Strategy: Healthy lifestyles Access to primary care 2 Sparrow Ionia Hospital | February 2013 Appendix P
Introduction ___________________________ Purpose of this Report As a community‐based hospital, the mission of Sparrow Ionia Hospital is “to improve the health of the people in our communities by providing quality, compassionate care to everyone, every time.”2 The purpose of this report is to assess the health status and health issue concerns within this community in order for Sparrow Ionia Hospital staff to identify and understand the community’s most pressing health care needs and to suggest activities and services to address these needs and concerns. The results of this assessment will provide the basis for developing a set of specific actions that Sparrow Ionia Hospital, in collaboration with other community partners, may undertake to resolve these issues and concerns and, ultimately, improve the health status of the community at large and the health of its individual residents. Although Ionia County is not part of the geographic area represented by the Healthy! Capital Counties (H!CC) Collaborative, this community health needs assessment (CHNA) was modeled on the assessment conducted by the Collaborative in the Greater Lansing area over the past eighteen months. H!CC is a consortium of hospitals and community health departments in the tri‐county Lansing area, comprising Clinton, Eaton, and Ingham Counties. Sparrow Health System is a leading participant in the H!CC Collaborative, and much of the information presented in the CHNA for the Greater Lansing area has been used to provide a relevant set of comparisons for the health indicators presented for Ionia County. This report is designed to be used by Sparrow Ionia Hospital along with public and private organizations throughout Ionia County, Michigan, as a benchmark for improving the health and well‐being of every resident of this area. Data Gathering The information presented in this CHNA has been gathered from two principal sources. 2
Sparrow Health System. Accessed December 19, 2012. http://www.sparrow.org/missionvision/.
3
P
Statistical information about the population of the community served by Sparrow Ionia Hospital, the social and economic characteristics of the community, and the health care experiences and characteristics of the residents of the community are derived from a variety of standard sources of information including the Centers for Disease Control and Prevention (CDC), the Michigan Department of Community Health (MDCH), and the Bureau of the Census. Much of this statistical information was provided to Sparrow Health System by the Ingham County Health Department. This statistical information has been supplemented by interviews conducted with residents of the community served by Sparrow Ionia Hospital and interviews with public health officials in Ionia County. These interviews provide balance to the statistical information provided by incorporating the insights and perceptions of the community’s residents, including their perceptions of what they believe are the most important health care issues within the community and their suggestions as to what should be done about them. Although the identities of these contributors are confidential, a list of the types of people who participated is provided in Appendix B. Report Content This assessment contains the following information: A profile of the demographic, socioeconomic, and health status characteristics of the community served by Sparrow Ionia Hospital. Twenty five one‐page community indicator reports that provide specific data for the six‐county region served by Sparrow Health System’s four community hospitals, including comparative data for the State of Michigan. These indicator pages also provide some additional details about the indicators, the sources of information, and comments about the issues that the indicator reflects that have been gleaned from interview and focus groups participants. A brief list of health resources within the Sparrow Ionia Hospital service area. Findings that identify the most important health care concerns and issues within the community based on the data presented. 4 Sparrow Ionia Hospital | February 2013 Appendix P
Sparrow Ionia Hospital Area Profile______ Lansing area community residents and leaders interviewed for the Sparrow Health System Community Health Needs Assessment reported their perceptions of the health status of community residents in this region are mainly “Fair” to “Good.” Community Leadersʹ Perceived Area Health Status, 2012 (1 = Very Poor, 6 = Excellent)
Six‐County Area
3.66
Sparrow Clinton
3.8
Sparrow Ionia
3.86
Sparrow Lansing
3.33
Sparrow Specialty
3.75
0
1
2
3
4
5
6
This response is in contrast to the perceptions of individuals’ own health status as reported in the 2010 Behavioral Risk Factor Survey for this area. In that study 57 percent of area residents indicated that their personal health status was excellent or very good; 16 percent reported their own health status as fair or poor. Despite these relatively healthy findings, there are considerable health care issues and health care needs evident throughout much of the Sparrow Hospital service area as revealed through the statistical profiles provided in the following pages and through the comments provided through interviews with community leaders. 5
P
Sparrow Ionia Hospital Profile Ionia County has a population of 63,905
residents, as reported in the 2010 Census of
Population. Ionia County is the second
smallest county in the six-county Sparrow
Health System (SHS) service area. Although
Ionia County is roughly half-way between the
Lansing and Grand Rapids areas of influence,
basic health care services are provided by
Sparrow-Ionia Hospital while more advanced
health care services are provided by hospitals
in Lansing and Grand Rapids, respectively.
Ionia County is characterized by a mixed
economy consisting of manufacturing,
agriculture, and government. The major Ionia
County employer is the State of Michigan
Department of Corrections.
Population Characteristics – Ionia County
Ionia County Population by Race
0.5% 1.3%
1.4%
4.7% 0.4%
White
African‐
American
Asian
American
Indian/Alaskan
Native
Other
91.7%
Multi‐racial
• Population size: 63,905
• Age breakout:
0 – 4: 6.4%
5 – 14: 13.7%
15 – 44: 41.4%
45 – 64: 27.0%
65 – 74: 6.5%
75 and over: 4.9%
• Median age: 37.0 years
• Racial composition:
White: 91.6%
African American: 4.7%
American Indian/Alaska Native: 0.5%
Asian: 0.4%
Multi-racial: 1.4%
Other: 1.3%
Native Hawaiian/Pac. Islander: None
• Ethnic composition:
Hispanic: 4.5%
Non-Hispanic: 95.5%
Source: Bureau of the Census, 2010 Census of Population
6 Sparrow Ionia Hospital | February 2013 Appendix P
Social and Economic Indicators – Ionia County
Indicator
Definition
Percentage
Income
Children below 18 in poverty
21.0%
Family
Single parent households
10.8%
Education
Safety
Affordable Housing
Environment
Population age 25+ with a high
school degree
Population age 25+ with a
Bachelor’s degree or higher
Rate of violent crimes per 100,000
person
Percentage of households that spend
more than 30% of income on
housing
Population density per square mile
Relationship to
Michigan
86.7%
13.1%
156.6
34.5%
111.9 people
per mile2
Lower Density
More favorable than the statewide average
About average
Less favorable than the statewide average
Source: Bureau of the Census, American Community Survey, 2006-2010; 2010 Census of Population; Michigan State
Police, 2010.
Ionia County is similar to the statewide average for several of the social and economic indicators identified above, including percentage of children living in poverty, single parent households, affordable housing (households that spend 30% or more of income on housing), and the percentage of the population that has a high school degree. Although 90% of adults age 25 or more are high school educated, only 13% of the adult population holds a bachelor’s degree; the latter percentage is considerably below the statewide average for college graduates. This figure also is impacted by the thousands of state correctional inmates housed in Ionia County, few of whom have more than a high school education. Although thousands of convicted criminals are housed in four correctional facilities in Ionia County, this is a relatively safe community with a rate of violent crimes well below the statewide average. 7
P
Health Indicators – Ionia County
Indicator
Child Health
Definition
Rate of preventable asthma
hospitalizations per 10,000 children
Results
4.3 per 10,000
Quality of Life
Perceived health status as “fair” or “poor”
Adult Health
Rate of preventable diabetes-related
hospitalizations among adults
13.6 per
10,000
Premature Deaths
Percentage of deaths prior to age 75
50.6%
Maternal and
Child Health
Safety Policies/
Practices
Low birth weight and very low birth
weight babies
Age-adjusted death rate due to accidental
injury
About average
Source: Michigan Department of Community Health, 2012.
Comparison
With
Michigan
11.5%
65.7 per 1,000
live births
62.2 per
10,000
Ionia County children exhibit substantially lower rates of preventable asthma hospitalizations—a common indicator of community health—when compared to both the state average and the six‐county service area. Similarly, Ionia County has a relatively low rate of underweight babies. The percentage of premature deaths is also lower than the state average. Only 11.5 percent of residents perceive their health status as “fair” or “poor.” Adults have similar rates of diabetes‐related hospitalizations as found throughout the state. However, the rate of accidental deaths in Ionia County exceeds the statewide average; and the rate of fatalities from automobile accidents in Ionia County in 2011 (approximately 1.2 per 10,000 residents) was higher than the expected rate across the state (approximately 0.9 fatalities per 10,000 residents). Source: Michigan Department of Transportation, 2011 Michigan Traffic Crash Facts. Lansing, MI; Michigan Office
of Highway Safety Planning, 2012.
Behavior, Physical Condition, and Access to Care Indicators –
Ionia County
Indicator
Definition
Percentage
Percentage of adults who are obese
30.7%
Percentage of adolescents who are obese
18.9%
Comparison
With Michigan
Obesity
Tobacco Use
Alcohol Use
Access to Care
Prevention
Mental Health
Percentage of adults who currently
smoke
Percentage of adolescents who smoked
in the past month
Percentage of adults who binge drank in
past month
Percentage of adolescents who binge
drank in past month
Percentage of residents lacking a
primary care physician
Percentage of population enrolled in
Medicaid
Ratio of population per primary care
physician
Percentage of children 19 to 35 months
old with recommended vaccinations
Percentage of adults who report their
mental health is “not good”
15.4%
13.9%
15.8%
17.4%
13.4%
10.7%
2670 per
physician
81.0%
14.0%
About average
Source: Michigan Department of Community Health, Michigan Behavioral Risk Factor Survey, 2008-2010; Health
Resources and Services Administration, Area Resource File, 2010.
Prevelence of Overweight and Obese Adults in the SHS Service Area as Indicated by Body‐Mass Index (BMI) Obese Adults
90%
Overweight Adults
80%
70%
60%
50%
40%
49.5%
29.3%
30.7%
25.0%
22.0%
33.9%
36.2%
32.3%
35.8%
30.1%
Clinton
Eaton
Gratiot
Ionia
Ingham
24.1%
30%
20%
10%
47.6%
0%
Shiawassee
Source: Michigan Behavioral Risk Factor Survey, 2008-2010
9
P
Community Health Indicators ___________ The indicators listed in Table 1, below, are presented in the following pages. They are grouped within the following categories: Social, Economic, and Environmental Indicators: Children in Poverty; Single Parent Households; Education; Community Safety; Housing Costs; Nitrate Levels in Well Water (environmental quality) Health Behavior Indicators: Adult Obesity; Youth Obesity; Adult Tobacco Usage; Youth Tobacco Usage; Adult Alcohol Consumption; Youth Alcohol Consumption Clinical Care Indicators: Access to Physicians; Preventable Hospitalizations (Ambulatory‐Sensitive Admissions); Medicaid Enrollment; Health Insurance Coverage; Childhood Immunization Mental Health Indicators: Adult Mental Health; Youth Mental Health Morbidity and Mortality Indicators: Perceived Health Status; Infant Mortality; Low Birth‐weight Babies; Premature Deaths; Cardiovascular Disease; Accidental Deaths 11 P
Table 1: Indicator Data Sources
Indicator
Children in Poverty
Single Parent Households
Housing Costs
Education
Community Safety
Environmental Quality
Obesity Among Adults
Obesity Among Young People
Tobacco Use Among Adults
Tobacco Use Among Youth
Alcohol Use Among Adults
Alcohol Use Among
Adolescents
Access to Physicians
Preventable Hospitalizations
Medicaid Enrollment
Health Insurance Coverage
Disease Prevention:
Immunization
Mental Health (Adults)
Mental Health (Youth)
Perceived Health Status
Infant Mortality
Low-Weight Births
Premature Deaths
Cardiovascular Disease
Accidental Deaths
Data Source
Bureau of the Census, American Community Survey
Michigan State Police, Michigan Incident Crime Reporting
Michigan Department of Environmental Quality
Capital Area Behavioral Risk Factor Survey
Michigan Behavioral Risk Factor Survey
Michigan Department of Education, Michigan Profile for Health
Youth (MiPHY)
Michigan Department of Community Health, Michigan Youth Risk
Behavior Survey
Youth (MiPHY)
Behavior Survey
Youth (MiPHY)
Health Resources and Services Administration, Area Resource File
American Association of Medical Colleges
Michigan Department of Community Health, Michigan Resident
Inpatient Files
Michigan Department of Community Health
Bureau of the Census, Small Area Health Insurance Estimates,
American Community Survey
Michigan Department of Community Health, Michigan Care
Improvement Registry
Youth (MiPHY)
Behavior Survey
Michigan Department of Community Health, Michigan Infant
Mortality Tables
Michigan Department of Community Health
Death File
Death File
Death File
Year
2006-2010
2006-2010
2006-2010
2006-2010
2010
1988-2011
2008-2010
2008-2010
2006-2010
2012
2009
2008-2010
2008-2010
2012
2009
2008-2010
2010
2006-2010
2012
2009-2010
2011
2010
2012
2009
2012
2008-2010
2010
2012
2011
2008-2010
2006-2010
2000-2010
2010
2010
2010
Children in Poverty Measure. Children in poverty is the percentage of children living in households with incomes below the 2010 Federal Poverty Threshold as determined annually by the Census Bureau. For 2010, the poverty threshold ranged from $15,030 for a family with one adult below age 65 and one child to as much as $43,845 for a family with two adults and seven or more children. Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Multi‐year estimates are used to estimate data for smaller areas such as cities and counties. Importance of this measure. The percentage of children in poverty has been shown to be closely associated with a variety of poor health behaviors, negative health effects, and negative outcomes including higher incidence +-
of disease and premature death. Residence of Children At or Below the Poverty Level in Ingham County, 2010 (N = 12,418 children at or below poverty)
Balance of County
29%
Lansing
71%
Source: American Community Survey, 2006‐2010 Percentage of Children In Poverty, 2010
Michigan
19.8%
Six‐County SHS Service
Area
17.7%
Tri‐County Lansing Area
Clinton County
16.7%
6.8%
Eaton County
12.1%
Ingham County
22.4%
Gratiot County
23.0%
Ionia County
21.0%
Shiawassee County
0.0%
19.0%
10.0%
20.0%
30.0%
Source: American Community Survey, 2006‐2010
The overall percentages of children in poverty are lower for both the Lansing tri‐
county area and the entire 6‐county SHS service area than for the entire state. The percentage of children in poverty exceeds the statewide average in Ingham, Gratiot, and Ionia counties. Of more than 12,000 children in poverty in Ingham County, 71% reside in the City of Lansing.
“Kids are the poorest population in the US. They have the least voice and the people who care for them are paid the least.” 13 P
Single Parent Households Source: Health Matters in San Francisco.
http://www.healthmattersinsf.org/
Perecentage of Michigan Children in Single Parent Households by Race, 2010
All
Michigan
9.5%
Six‐County SHS Service
Area
9.4%
Clinton County
8.7%
Ingham County
9.4%
Gratiot County
10.3%
Ionia County
10.8%
Shiawassee County
10.3%
0%
5%
10%
15%
Source: American Community Survey, 2006‐2010. Both the Tri‐county area and the six‐county service area have slightly lower percentages of single parent households than the state as a whole. Locally, the rate is highest in Ionia County at 10.8 percent and lowest in Clinton County at 7.7 percent. Both Gratiot and Shiawassee counties also have percentages higher than the statewide average at 10.3 percent. 73%
Asian/Pacific Islander
7.7%
Eaton County
34%
African American
9.0%
8.0%
6.0%
8%
Percentage of Children Living in Households Headed by a Grandparent
6.2%
5.2%
5.9%
5.8%
Ingham
Percentage of Single Parent Households
Ionia
Measure. This measure reflects the percentage of households in which a single parent is raising at least one child. Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Importance of this measure. Children in single‐parent households are at a higher risk for adverse health effects, such as emotional and behavioral problems, compared to their peers. Children in such households are more likely to develop depression, smoke, and abuse alcohol and other substances. Consequently, these children experience increased risk of morbidity and mortality of all causes. Similarly, single parents suffer from lower perceived health and higher risk of mortality. 6.6%
4.1%
4.0%
0%
20% 40% 60% 80%
Source: Annie E. Casey Foundation, Kids Count data, 2012.
0.0%
Source: American Community Survey, 2006‐2010.
Shiawassee
25%
Gratiot
White (non‐Hispanic)
2.0%
Eaton
41%
Clinton
Hispanic
Housing Costs Measure. This measure is the percentage of households that spend more than 30 percent of their total household income on housing. Data source & year. U.S. Census Bureau, American Community Survey 2006‐2010. Importance of this measure. The percentage of income that a family spends on housing is directly related to the amount of income available for other expenses such as health insurance, transportation, heat, child care, and food items. high in sugars and fats. Percentage of Households with Housing Costs Greater than 30% of Income, 2010
Michigan
34.8%
Six‐County Region
33.7%
34.0%
Clinton County
29.1%
Eaton County
29.4%
Ingham County
37.1%
Gratiot County
30.8%
Ionia County
“A lot of people have left their community to find jobs or affordable housing due to these economic times.” “The way the economy is right now you have to choose between your health and paying your living expenses.” “A lot of people lost their house because they can’t cover the expensive hospital bills.” 34.5%
Shiawassee County
32.6%
0%
10%
20%
30%
40%
Source: U.S. Census Bureau, American Community Survey 2006‐2010, Table S2503.
Both the tri‐county region and the six‐county service areas have similar portions of households with high housing costs relative to income as compared with the statewide average. Clinton and Eaton counties have a lower percentage of households in this category which may be attributed to higher average incomes in these areas. 15 P
Education Measure. Educational attainment is measured by the percentage of adults who are 25 years or older who have a bachelor’s degree or a higher level of education Data source & year. These data are from the Census Bureau’s American Community Survey for the period 2006 – 2010. Importance of this measure. There is thought to be a strong correlation between positive health outcomes and higher levels of education. There is also a well‐known relationship between higher education levels and greater economic opportunities which typically relate to healthier lifestyles. 15.0%
Adults 25 and Older With Less Than a HS Diploma
12.9%
12.0%
12.9%
10.1%
9.3%
10.0%
7.0%
7.6%
5.0%
Percentage of Adults over 25 with a Bachelorʹs Degree or Higher
Michigan
25.0%
Six‐County SHS
Service Area
26.2%
Tri‐County Lansing
Area
31.2%
Clinton County
27.2%
Eaton County
24.3%
Ingham County
35.5%
Gratiot County
13.5%
Ionia County
13.1%
Shiawassee County
0.0%
14.9%
10.0%
20.0%
30.0%
40.0%
Source: American Community Survey, 2006‐2010. Both the tri‐county area and the six‐county service area have higher rates of adults with college degrees compared to the statewide average. The lowest rates of educational attainment are found in Gratiot, Ionia, and Shiawassee counties where about 14 percent of people over age 25 have a bachelor’s degree or higher. This is in sharp contrast to a much higher than average rate in Ingham County, where Michigan State University is located.
Shiawassee
Ionia
Ingham
Gratiot
Eaton
Clinton
Michigan
0.0%
Source: American Community Survey, 2006‐2010. “Making the kinds of decisions that abandon or undervalue education will kill you in the end. An uneducated population dies quicker.” 16 Sparrow Ionia Hospital | February 2013 Appendix P
Community Safety Measure. Community safety is represented by the rate of violent crimes per 100,000 residents per year. Violent crimes are annual incidents of murder and non‐negligent homicide, first‐degree rape, robbery, and aggravated assault, as reported by the Michigan State Police. These crimes are all crimes against people and, thus, represent the personal safety (or lack of safety) within each of the areas. Data source & year. These data are reported in the 2010 Michigan Incident Crime Reporting tabulations prepared by the Michigan State Police. Importance of this measure. In addition to reflecting the level of personal safety, crime generates stress among community residents, thus potentially undermining their psychological well‐being. High levels of crime may also deter community residents from outdoor activities and may add stress to participation in education and community activities. While all of the counties examined show lower violent crime rates than was reported for the entire state of Michigan in 2010, Ingham County exhibited only a marginally lower rate at that time. Almost two‐thirds of the violent crimes in Ingham County occurred within Lansing. This indicates a higher potential level of stress that may be associated with health problems in the city. Violent Crime per 100,000 Persons, 2010
489.9
Michigan
270.6
Six County SHS Service Area
313.2
60.9
Clinton County
159.5
Eaton County
438.7
Ingham County
91.5
Gratiot County
156.6
Ionia County
204.3
Shiawassee County
0
100
200
300
400
500
600
Source: Michigan State Police. Michigan Incident Crime
Reporting (MICR): 2010 All Offenses Reported by
County/Agency.
Average Number of Violent Crimes in Lansing and the Balance of Ingham County, 2008‐2010
Balance of County, 1537
Lansing, 2787
17 P
Environmental Quality Measure. Water samples were tested for the level of nitrate in the water. This measure is the percentage of well water samples that exhibit nitrate levels in water that are above the Environmental Protection Agency standard of 10 milligrams per liter. Data Source & Year. Michigan Department of Environmental Quality, 1988 – 2011. This information is drawn from periodic tests of private water wells. Importance of this Measure. High nitrate levels in water may be related to the inappropriate or unsanitary disposal of human, animal, or industrial waste products. High nitrate levels in water can cause serious illnesses among infants below six months of age (methemoglobinemia).
High nitrate levels may also be an indicator of other contaminants in the water. (See Michigan Department of Environmental Quality. Nitrate in Drinking Water: Information for private water well owners. (Brochure, 2003.) Source:
http://www.michigan.gov/documents/deq/deqwd-gws-ciu-nitratebrochure _270430_7.pdf Percentage of Well Samples with Nitrate Levels Above the Maximum Containment Level*
Michigan
N.A.
0.9%
Clinton
0.5%
Eaton
1.4%
0.7%
Ingham
Gratiot
3.1%
Ionia
5.2%
Shiawassee
1.1%
0%
1%
2%
3%
4%
5%
6%
Source: Michigan Department of Environmental Quality.
1988-2011.
* These data are meaningful only for localities and
households that are not served by municipal water systems
that are routinely tested for contaminants.
Although water quality is an important concern among environmentalists and community health specialists, environmental quality issues such as concerns about high levels of ground water contamination, air pollution, industrial pollution, or lead in house paint were also raised during the interviews and focus groups conducted for this project. “I am worried about the health effects of pesticides and steroids in food products.” “[I have concerns about] historical problems, such as abandoned manufacturing plants that have led to significant groundwater issues.” 18 Sparrow Ionia Hospital | February 2013 Appendix P
Obesity Among Adults Measure. Overweight adults are defined as having a body‐mass index (BMI) of 25.0 to 29.9. Obese adults have a BMI of 30.0 and above. BMI is a calculation which takes into account both height and weight. Data source & year. BMI was calculated from height and weight data submitted by sample participants in the Behavioral Risk Factor Surveillance System surveys conducted in Michigan between 2008 and 2010. Importance of this measure. The relationship of obesity to a number of serious chronic diseases among adults has been well documented. Foremost among obesity‐related maladies are diabetes, heart disease, high blood pressure, and liver disease. Adults Who are Overweight or Obese
2008‐2010
Overweight
35.1%
6‐County Region
34.1%
Tri‐County Region
32.1%
Clinton County
33.9%
25.0%
Eaton County
36.2%
22.0%
Ingham County
30.1%
Gratiot County
32.3%
Ionia County
35.8%
Shiawassee County
“Obesity keeps increasing – if we can expand the communication and educational opportunities to make people aware of the problem, perhaps we can control this problem.” “In our obesity prevention efforts, people agree with us mentally but in practice [they] go back to offering candy as rewards.” Among interviewees, obesity was the most frequently listed top health issue in communities serviced by Sparrow Health System. 31.7%
Michigan
Obese
26.7%
23.8%
24.1%
49.5%
30.7%
29.3%
47.6%
Source: 2008-2020 Capital Area Behavioral Risk Factor
Survey; 2008-2010 Michigan BRFSS; American
Community Survey, 2006-2010.
Two‐thirds of adults age 18 and over in Michigan are either overweight or obese. Adults in the Tri‐County Lansing Area exhibit lower rates of overweight and obesity in most cases. Adults in Gratiot and Shiawassee counties exceed both regional and statewide levels. Obese Adults by Race and Ethnicity in Michigan, 2009
50%
42.6%
41.6%
28.7%
0%
Black non‐Hispanic
White non‐
Hispanic
Hispanic
19 P
Obesity Among Young People Measure. Overweight youth are those who are at or above the 85th percentile and below the 95th percentile for body‐
mass index (BMI) by age and sex. Obese youth are at or above the 95th percentile for BMI by age and sex. Data source & year. County data were drawn from the 2012 Michigan Profile for Healthy Youth (MiPHY) survey which is conducted among a sample of students in the 7th, 9th, and 11th grades in selected schools in selected districts in each county. Students in 31 of 72 school districts in the six‐county area participated, including those in 36 of 143 middle school buildings and 35 of 125 high school buildings. Statewide comparative data are from the 2009 Michigan Youth Risk Behavior Survey. Importance of this measure. Over‐
weight and obese youth exhibit both current and future risk factors, including risk for heart disease, diabetes, stroke, and cancer. Over‐ weight youth are also are at a greater risk for being socially stigmatized and having poor self‐esteem. “People try to fill their bellies and don’t
worry about health necessarily.
Families may eat better at the
beginning of the month than [at] the
end due to financial limitations.”
“It’s a national disease frankly. I think
it’s going to get worse because kids
don’t go out and get exercise. Schools
are cutting back on gym and athletics.
It’s driven by revenue.”
Youth Who Are Overweight or Obese
2011‐2012
Overweight
Obese
14.2%
11.9%
Michigan*
6‐County Region
15.9%
14.4%
Tri‐County Region
15.6%
13.6%
Clinton County
15.7%
Eaton County
15.2%
15.2%
Ingham County
15.2%
14.0%
Shiawassee County
17.4%
Ionia County
16.8%
Gratiot County
17.3%
10.0%
12.3%
16.5%
18.2%
* 2009
Source: Michigan Department of Education, 2012 Michigan Profile for
Healthy Youth; Michigan Department of Community Health, 2009
Michigan Youth Risk Behavior Survey. Regional data calculated by PPA.
* 2009 data.
Between 25% and 35% of youth in each of this region’s counties are overweight or obese, with some of the highest rates reported in the more rural areas. In all cases, these rates exceed the statewide levels recorded in 2009. Overweight and Obese Youth in the Sparrow Service Area, 2011‐2012
Obese
14%
Not Overweight
70%
Overweight
16%
Tobacco Use Among Adults Measure. Tobacco use among adults is measured as the percentage of the adult population that reported smoking every day or most days and has smoked at least 100 cigarettes in their lifetime. Data source & year. Smoking data are from the 2008‐2010 Capital Area 2008‐
2010 Michigan Behavioral Risk Factor Surveys. Importance of this measure. Despite years of publicity regarding the health dangers associated with tobacco use, about 20 to 25 percent of the adult population continues to smoke. Smoking has a variety of direct and indirect health consequences, including lung cancer, other pulmonary diseases, and heart disease. Indirect consequences include both low birth weight and the possibility of disease among those exposed to second hand smoke. As noted in the Healthy! Capital Counties CHNA Report, tobacco use may also indicate the need for smoking cessation programs or illustrate the effectiveness of existing programs. Perecentage of Current Adult Smokers
Michigan
18.9%
Six‐County SHS Service Area
21.6%
22.3%
Clinton County†
16.4%
Eaton County†
28.8%
Ingham County†
21.4%
Gratiot County*
Ionia County*
Shiawassee County*
28.8%
15.4%
18.7%
0% 5% 10% 15% 20% 25% 30% 35%
† Source: 2008‐2010 Capital Area Behavioral Risk Factor Survey * Source: 2008‐2010 Michigan Behavioral Risk Factor Survey Tobacco use in the six‐county Sparrow Health System service area is slightly higher than the state as a whole. Higher percentages of adults use tobacco in Eaton and Gratiot counties, while both Clinton and Ionia counties have much smaller percentages of users. “There are programs out there to educate, but there are people who ignore it.” “[It] was a high priority five to ten years ago, but [it] seems to have dropped off.” 21 P
Tobacco Use Among Youth Measure. Tobacco use among youth is measured as the percentage of young people who reported smoking cigarettes during the past 30 days. Data source & year. These data are drawn from the Michigan Department of Education, Michigan Profile for Healthy Youth (MiPHY), 2010 and the 2008‐2010 Capital Area Behavioral Risk Factor Survey. Importance of this measure. One of the successful outcomes of years of promoting the dangers of smoking and has been a decline in the prevalence of smoking among young people in recent years. Despite this, some young people continue to take up smoking each year. As is widely known, smoking has a variety of direct and indirect health consequences, including lung cancer, other pulmonary diseases, and heart disease. Indirect consequences include both low birth weight and the possibility of disease among those exposed to second hand smoke. As noted in the Healthy! Capital Counties CHNA Report, tobacco use may also indicate the need for smoking cessation programs or the effectiveness of existing programs. “I fear for smoking. I see way too many young people smoking.” “We were doing more a few years ago.”
Percentage of Students Who Smoked Cigarettes in the Past 30 Days
Michigan*
14.0%
Six County Region
6.7%
Clinton
6.1%
4.0%
Eaton
Ingham
Gratiot
Ionia
Shiawassee
* Michigan 2010 BRFS
9.4%
5.4%
8.9%
9.4%
9.1%
0% 2% 4% 6% 8% 10% 12% 14% 16%
Source: 2008-2010 Capital Area Behavioral Risk Factor
Survey; 2008-2010 Michigan Behavioral Risk Factor Survey.
Within the six‐county Sparrow Health System service area the percentage of youth that report having smoked a cigarette in the last 30 days is significantly lower than that for the state as a whole. The highest rates of tobacco use are found in the more rural counties within the SHS service area. The Lansing tri‐county region has a lower rate of youth tobacco use than the six‐county region overall with the highest rate found in Eaton County. This may be indicative of the scope and reach of current and past smoking cessation efforts. 22 Sparrow Ionia Hospital | February 2013 Appendix P
Alcohol Use Among Adults Measure. Binge drinking is defined as the percentage of adult males who had 5 or more and adult females who had 4 or more drinks of alcohol in a row within a short period of time during the past 30 days. Data source & year. These data are from the 2008‐2020 Capital Area Behavioral Risk Factor Survey; the 2008‐2010 Michigan Behavioral Risk Factor Survey; American Community Survey, 2006‐2010; and the Centers for Disease Control, Vital Signs, Binge Drinking. Importance of this measure. Adult binge drinking causes 80,000 deaths in the US each year and, in 2006 cost the economy $223.5 billion. This behavior can lead to increased incidents of violence, automobile accidents, suicide, unplanned pregnancies, spread of sexually transmitted diseases, and fetal alcohol syndrome. Community coalitions with a broad set of partners that includes educators, public safety, public health officials, and community leaders can help address this issue. “[We are] dealing with people who are addicted or drunk all the time. How do you motivate people to get out of where they’re stuck?” Binge Drinking Among Adults, 2008‐
2010
Michigan*
19.7%
Six‐County Region
17.8%
17.8%
Clinton County
17.9%
Eaton County
20.7%
Ingham County
16.7%
Gratiot County
18.7%
Ionia County
15.8%
Shiawassee County
0.0%
19.5%
10.0%
20.0%
30.0%
Source: 2008‐2020 Capital Area Behavioral Risk Factor Survey; 2008‐
2011 Michigan BRFSS; American Community Survey, 2006‐2010. 25.0%
20.0%
Binge Drinking by Race and Ethnicity in Michigan, 2011
19.7%
20.5%
20.4%
21.6%
15.6%
15.0%
10.0%
5.0%
0.0%
Michigan
White
Black
Other
Hispanic
23 P
Alcohol Use Among Adolescents Measure. Binge drinking is defined as the percentage of students who had 5 or more drinks of alcohol in a row, that is, within a couple of hours, during the past 30 days. Data source & year. County data were drawn from the 2012 Michigan Profile for Healthy Youth (MiPHY) survey which is conducted among students in the 7th, 9th, and 11th grades in selected schools in selected districts in each county. Regional data were calculated by the authors. Students in 31 of 72 school districts in the six‐county area participated, including those in 36 of 143 middle school buildings and 35 of 125 high school buildings. Statewide data are from the 2009 Michigan Youth Risk Behavior Survey. Importance of this measure. Alcohol consumption among adolescents may have a negative effect on brain development as well as negatively effecting liver and endocrine system development. Binge drinking can also lead to risk‐taking behaviors that might result in negative health outcomes such as sexually transmitted diseases, unplanned pregnancies, traffic‐related injuries, or alcohol poisoning. Binge Drinking Among High School Students, 2011‐2012
Michigan
Six‐County Region
Clinton County
23.2%
12.8%
12.3%
12.8%
Eaton County
Ingham County
Gratiot County
16.1%
10.9%
13.8%
Ionia County
Shiawassee County
0.0%
17.4%
10.7%
5.0% 10.0% 15.0% 20.0% 25.0%
Source: American Community Survey, 2006-2010
The data indicate that the six counties that Sparrow Health System serves all perform much better than the state as a whole on this indicator. While the rates are higher in Eaton and Ingham counties, these areas are still below the statewide average. “I see a lot of alcohol being served in the area, including high school graduation parties, weddings, and party stores.” “There is still a lot of drinking and driving going on in this county. People think because you’re on a country road it’s okay.” 24 Sparrow Ionia Hospital | February 2013 Appendix P
Access to Physicians 1017
Clinton County
2494
Eaton County
1907
Ingham County
762
Gratiot County
1323
Ionia County
2670
Shiawassee County
2530
0
1000
2000
3000
Source: Health Resources and Services Administration,
Area Resource File, 2009-2010; American Association of
Medical Colleges, 2011.
While the Lansing area and the entire six‐county Sparrow Service Area have an average number of physicians available for the population served, the Lansing area and Ingham County, in particular, report more than 1 in 4 residents does not have a primary care physician. Percentage Lacking Access to a Primary Care Physician, 2008‐2010
40%
21.6%
14.8%
12.5%
14.0%
13.4%
10%
NA
0%
Shiawassee
County
20%
29.1%
25.4%
30%
Ionia
County
“The emergency room becomes their primary care vehicle since primary care is not really available without insurance.” Tri‐County Lansing Area
Gratiot
County
“Ingham County is not underserved as far as number of physicians to population ratio.” 1114
Ingham
County
“Many people are reluctant to drive into Lansing, so if the required resources are not available many people go without” Six‐County Region
Eaton
County
1034
Clinton
County
Michigan
Lansing
Area
Population per Primary Care Physician, 2009‐2010
Michigan
Measure. The measure on the top right is the number of total residents per primary care physician (including general medicine, family practice, internal medicine, pediatrics, or gynecology). Below is the percentage of the resident population that does not have a primary care physician for routine health care needs. Data source & year. Data are from the U.S. Department of Health & Human Services, Health Resources and Services Administration (HRSA), Area Resource File, 2009‐2010, the American Association of Medical Colleges (AAMC), and the Behavioral Risk Factor Survey, 2008‐2010. Importance of this measure. Primary care serves as the gateway to health through the provision of preventive care services, treatment for basic health needs, and referrals to specialized care when needed. Lack of access to primary care may delay treatment for minor problems that, with time, may become serious concerns with life‐
threatening consequences. Source: American Community Survey, 2006‐2010 25 P
Preventable Hospitalizations Measure. Preventable hospitalizations are those which typically do not require inpatient services for treatment. Common preventable hospitalizations diagnoses are diabetes for adults and asthma for children. Data source & year. These data are from the Michigan Department of Community Health, 2010 Michigan Resident Inpatient Files. Importance of this measure “High rates of Ambulatory Care Sensitive hospitalizations in a community may be an indicator of a lack of or failure of prevention efforts, a primary care resource shortage, poor performance of primary health care delivery systems, or other factors that create barriers to obtaining timely and effective care.” Michigan Department of Community Health. http://www.mdch.state.mi.us/pha/osr/CHI/HOSP/I
NSTRUC2.htm
14.3
Area
Michigan
268.4
Eaton
212.1
Clinton
181.1
Ingham
218.3
Ionia
184.2
Gratiot
325.8
Shiawassee
209.6
0
50
100
150
200
250
300
350
Source: Michigan Department of Community Health,
2010 Michigan Resident Inpatient Files.
The tri‐county area has a much higher rate of preventable hospitalizations due to asthma per 10,000 children younger than 18 than does the state as a whole. Ingham County performs much worse on this measure than does Clinton or Eaton counties. (See chart at left.) Example: Preventable Hospitalizations Due to Asthma per 10,000 Children Below Age 18
Michigan
Preventable Hospitalizations per 10,000 Population, 2010
21.4
12.4
Clinton County
18.1
Eaton County
25.6
Ingham County
0
10
20
30
“Routine physical exams. Yes if you have insurance. If you don’t, that’s the last thing that you’re going to do. Of all the issues, that’s probably the biggest gap. If we can catch some of this stuff earlier, it would be better/save money.” 26 Sparrow Ionia Hospital | February 2013 Appendix P
Medicaid Enrollment Measure. This measure reflects the percentage of residents enrolled in any Medicaid Health Plan. Data source & year. These data are August 2012 enrollment figures from the Michigan Department of Community Health. Importance of this measure. Because accurate measurements of uninsured individuals are not standardized, accurately measuring the percentage of Medicaid enrollees can help provide firmer estimates for health insurance coverage in the region. (http://www.chis.ucla.edu/dataquali
ty6.html). This indicator is also helpful in determining an area’s demand for services and providers that accept Medicaid patients. Percentage of Residents Enrolled in Medicaid
Michigan
12.3%
10.6%
10.2%
Clinton County
Eaton County
6.2%
8.3%
Ingham County
11.9%
Gratiot County
12.0%
Ionia County
Shiawassee County
10.7%
12.2%
0% 2% 4% 6% 8% 10% 12% 14%
Source: Michigan Department of Community Health, 2012
Both the tri‐county area and the six‐county service area have a lower percentage of residents enrolled in a Medicaid Health Plan than that state as a whole. Clinton County enrollment is the lowest, with only 6.2% of residents enrolled in a Medicaid Health Plan. “We’re not a physician shortage area, but we’re low on specialists in this area. Specialists don’t see uninsured or Medicaid, so we need more access to that.” “Dental and some of the specialty care is largely restricted if you’re on Medicaid. In our area, there is one dentist . . . who will see Medicaid [patients]. If [a] kid is in hospital, they [physicians] will see them, but not in office.” 27 P
Health Insurance Coverage Measure. This is the percentage of the entire non‐institutionalized population that reported not having any form of health insurance, including commercial insurance, Medicare, Medicaid, military services health care, or other health insurance. Data source & year. These data are from the Bureau of the Census, 2009 Small Area Health Insurance Estimates. Regional estimates were calculated by the authors. Importance of this measure. The lack of health care insurance provides an estimate of the potential level of unmet health care needs in the community as well as the potential level of uncompensated care when uninsured individuals may need care provided by the emergency department of a local hospital. Percentage of the Population Without Health Insurance, 2009
Michigan
6‐county region
13.4%
Shiawassee County
13.6%
Percent Uninsured, Selected States, 2009‐2011 Average
Texas
24.6%
U.S.
16.1%
Michigan
Massachusetts
0.0%
13.9%
Ionia County
14.9%
Gratiot County
16.4%
3‐county region
12.9%
Ingham County
14.2%
Eaton County
11.3%
Clinton County
0.0%
10.3%
5.0%
10.0%
15.0%
20.0%
Source: Bureau for the Census, Small Area Health Insurance Estimates, 2009. Compared to the total percentage of uninsured people across the United States, Michigan has a relatively low proportion of residents without any form of health insurance. Only 13 states have a smaller proportion of their population that is uninsured. The rates presented above for Clinton, Eaton, and Ingham counties, in particular, compare very favorably with most of the rest of the nation. 12.4%
4.4%
10.0%
20.0%
30.0%
Source: U.S. Census Bureau, Current
Population Survey, 2009 to 2012 Annual
Social and Economic Supplements.
“People who don’t have health insurance put off getting care, and lot of small businesses don’t provide insurance.” “I see the real gaps where people don’t have insurance. Seems to me people who have insurance can get care. Physicians won’t take Medicaid because the reimbursement is so poor.” 28 Sparrow Ionia Hospital | February 2013 Appendix P
Disease Prevention: Immunization 100%
Percentage of Children Ages 19 to 35 Months with Recommended Immunizations, 2012
90%
80%
79%
81%
77%
81%
78%
76%
75%
70%
60%
50%
40%
30%
20%
10%
Shiawassee Co.
Ionia Co.
Ingham Co.
Gratiot Co.
Clinton Co.
Eaton Co.
0%
Michigan
Measure. This reflects the percentage of children 19 to 35 months of age who have received the recommended 4:3:1:3:3:1 series of immunizations (including immunization for polio, hepatitis B, measles, mumps, diphtheria, and several others). Data source & year. These data are from the Michigan Department of Community Health, Michigan Care Improvement Registry, June 2012. (http://www.mcir.org/index.html) Importance of this measure. Vaccinations received early in life provide lifelong immunity from several deadly childhood diseases (Healthy! Capital Counties, 2012). Protection against childhood diseases reduces deaths and improves long‐term health for individuals, and protects the community at large. Source: MDCH, “Michigan Immunization
Timely Tips.” April 2011.
“I worry about the parents who don’t follow up with immunizations. I am surprised that schools don’t do a better job.” “There is a lack of outreach and education when it comes to immunizations” Source: Michigan Department of Community Health,
Michigan Care Improvement Registry, June 2012.
Childhood Immunization by Race and Ethnicity, 2011
African
American
64.1%
72.1%
White
While these figures do not represent the immunization rates for the Greater Lansing area, the general pattern of disparity in the percentage of children immunized by race and ethnicity are likely to be found in this six‐county region. 78.5%
Hispanic
68.3%
Michigan
0%
50%
100%
29 P
Mental Health (Adults) Measure. This is the percentage of individuals age 18 and older reporting 14 or more days of poor mental health in the past 30 days. Data source & year. Data are from the 2008‐2010 Capital Area BRF & SC Survey; 2010 Michigan BRFSS; American Community Survey, 2006‐2010. Importance of this measure. The relationship between mental health and physical health is important to overall well‐being. As a determinant of quality of life, mental well‐being is positively correlated to physical well‐being. There are multiple facets to mental health included in this measure such as stress, emotional problems, and depression. Adults Reporting Poor Mental Health 2008‐2010
10.7%
Michigan
Six‐County Region
11.9%
11.8%
“We have facilities now that we did not have 10‐15 years ago, but affordability continues to be an issue.” 6.9%
Clinton County
14.5%
Eaton County
12.1%
Ingham County
6.4%
Gratiot County
14.0%
Ionia County
13.4%
Shiawassee County
0%
5%
10%
15%
20%
Source: 2008-2010 Capital Area BRF & SC Survey; 2010
Michigan BRFSS; American Community Survey, 20062010.
While both the six‐county and the tri‐county regions register a somewhat higher percentage of adults reporting poor mental health compared to the state as a whole, Clinton and Gratiot counties perform noticeably better on this measure. “There is a gap in mental health services; we don’t have adequate resources in terms of practitioners or facilities.” Adults Reporting Poor Mental Health, by Race and Ethnicity, 2010
20.0%
“Mental health services are no longer represented in the community, especially for the uninsured.” 14.7%
15.0%
10.4%
11.6%
10.4%
10.0%
5.0%
0.0%
White
Black
Other
Hispanic
Mental Health (Youth) Measure. This measure is the percentage of students (grades 7, 9, 11, and 12 in some cases) who report feeling sadness or hopelessness almost every day for at least 2 weeks in a row that results in not doing usual activities. This reflects feelings of stress, depression, and other emotional problems. Data source & year. These data are from the Michigan Profile for Healthy Youth Survey (MiPHY), 2012; Michigan Youth Risk Factor Survey, 2011. Importance of this measure. Mental health is an important component of overall health. Depression among youth not only may be manifest in feelings of sadness, defeat or hopelessness, but may interfere with school activities and may affect physical health as well. Adolescents With Symptoms* of Depression, 2011
Michigan
26.0%
Six‐County Region
27.1%
26.7%
Clinton
24.5%
Eaton
27.7%
Ingham
26.7%
Gratiot
29.4%
Ionia
29.2%
Shiawassee
Indicators of youth depression are slightly above the statewide average in mostly rural Gratiot and Ionia counties. Hispanic and African‐American youth report higher overall rates of depression than white youth in Michigan. Adolescents With Symptons of Depression by Race and Ethnicity, 2011
40%
30%
26.9%
0%
5% 10% 15% 20% 25% 30% 35%
*Self-reported feelings of sadness or hopelessness for 2
weeks or more.
Source: Michigan Department of Education; Michigan
Department of Community Health. Michigan Profile for
Healthy Youth, 2012 County Reports; CDC, National
Center for Health Statistics, Michigan Youth Risk Behavior
Survey, 2011. /mdoe.state.mi.us/MIPHYADMIN/reports/
CountyReport.aspx
34.5%
28.8%
24.3%
“[We are] seeing more kids with
mental health problems, but it is
very difficult to find treatment for
them.”
White
20%
10%
0%
Black
Hispanic
31 P
Perceived Health Status Measure. Health status is the percentage of adults who self‐
reported their health as “fair” or “poor” when asked “Would you say that in general your health is excellent, very good, good, fair, or poor?.” Data source & year. Capital Area Behavioral Risk Factor Survey 2008 – 2010; Ingham County Health Department. Importance of this measure. Perceived health status is indicative of quality of life, or those physical, emotional, and social items that contribute to one’s well‐being. Self‐ perceived health status can also be an important indicator for determining health care and health‐
related service demands for a community. Percentage of Adults with a ʺFair/Poorʺ Perceived General Health Status
Michigan
3.8
Sparrow Ionia
3.75
0
1
2
3
4
5
6
17.0%
Eaton County
16.0%
Ingham County
16.0%
Gratiot County
16.1%
11.5%
14.0%
5%
10%
15%
20%
Between 14 and 16 percent of the population throughout Michigan, the six‐county SHS service area, and the Greater Lansing Area perceive their own health status as “fair” or “poor.” Ionia County is an exception as only 11 percent report relatively poor health status. 3.33
Sparrow Specialty
Clinton County
Source: Capital Area Behavioral Risk Factor Survey, 2008‐2010; Ingham County Health Department. 3.86
Sparrow Lansing
16.2%
0%
Community Leadersʹ Perceived Area Health Status, 2012 (1 = Very Poor, 6 = Excellent)
Sparrow Clinton
Shiawassee County
3.66
15.5%
Ionia County
http://publichealth.lacounty.gov/ha/reports/ange
lenos/chapter4/angel4phs.pdf
Six‐County Area
14.2%
Interviews conducted for Sparrow Health System asked community and health care leaders to provide their perceptions of the general health status of the Greater Lansing area. They indicated that the health of area residents is good, but not excellent. 32 Sparrow Ionia Hospital | February 2013 Appendix P
Infant Mortality Measure. This is the average annual number of infant deaths for every 1,000 live births between 2006 and 2010. Data source & year. Data were obtained from the Michigan Department of Community Health, Michigan Infant Mortality Tables.; Center for Disease Control (CDC), Birth Outcomes; Center for Disease Control, Office of Minority Health and Health Disparities. Importance of this measure. According to the CDC, infant mortality is associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices. This indicator reflects factors associated with the health of the mother before and during pregnancy and also problems of infants including congenital abnormalities, pre‐term/low birth weight, Sudden Infant Death Syndrome (SIDS), and respiratory distress syndrome. Racial disparities also exist with infant mortality among African Americans occurring at nearly twice the national average, and according to the Indian Health Service, SIDS deaths among American Indian and Alaska Natives are 2.3 times the rate for non‐Hispanic white mothers. Centers for Disease Control. http://www.cdc.gov/reproductivehealth/Materna
lInfantHealth/InfantMortality.htm
“We could do a better job getting people who don’t have insurance hooked up earlier. We need more resources, especially at the ICHD level. A lot of it is awareness. Many of them have multiple other issues. If you have insurance or money, you get great prenatal care.” Average Annual Infant Deaths per 1,000 Live Births, 2006‐2010
Michigan
7.5
Six‐County Regioan
5.9
6.1
Clinton County
3.9
Eaton County
5.4
Ingham County
6.3
Gratiot County
8.7
Ionia County
3.9
Shiawassee County
4.9
0
2
4
6
8
10
Source: Michigan Department of Community Health, Michigan Infant
Mortality tables. http://www.mdch.state.mi.us/pha/osr/index.asp?Id=3
With the exception of Gratiot County, all of the counties in the SHS service area perform better on this indicator than the state as a whole. In Ingham County, the greatest percentage of infant deaths is reported in the city of Lansing. Average Annual Infant Deaths, Lansing & Balance of Ingham County, 2006‐2010
Balance of Ingham County
19%
Lansing
81%
33 P
Low‐Weight Births Low Weight Babies, Average per 1,000 Live Births
Measure. Babies that weigh less than 2,500 grams (5 pounds, 8 ounces) at the time of birth are considered low birth weight babies. About one in 12 babies born in the U.S. (83.3 per 1,000 live births) weigh less than 2,500 grams. Data source & year. These data are calculated from county birth data compiled by the Michigan Department of Community Health for the year 2000 through 2010. Michigan birth data may be found at 82.8
Michigan
75.3
6‐County Region
77.2
Tri‐County Region
69.1
Clinton County
70
Eaton County
81.3
Ingham County
http://www.mdch.state.mi.us/pha/osr/inde
x.asp?Id=2 Importance of this measure. Low birth weight may be an indicator of the health status of mothers in a community. There are several factors responsible for low birth weight, including chronic health problems among the mothers and poor pre‐natal care. There are also several implications for low birth weight babies early in life, including breathing problems, vision problems, learning problems, hearing loss, and cerebral palsy. Low birth weight risk can be reduced through improved pre‐natal care, better nutrition, smoking cessation, and other health improvements. 71.8
Gratiot County
65.7
Ionia County
74.8
Shiawassee County
0
20
40
60
80
100
Source: Michigan Department of Community Health, Michigan Natality The incidence of low birth weight babies in this region over the past 10 years compares favorably with statewide and national figures. Low birth weight babies in both the Lansing area as well as the entire 6‐county Sparrow Health System service area are about 10 percent below the statewide rate. The highest area rates are found in mainly urban Ingham County and mainly rural Shiawassee County. “If you have insurance or money you get great prenatal care. There are just gaps for people who don’t have insurance or money.” “When you look at some of the statistics I would say the overall health status is fair to poor. Particularly looking at low birth weight babies.” 34 Sparrow Ionia Hospital | February 2013 Appendix P
Premature Deaths Measure. Death prior to age 75 is considered premature death. Data source & year. These data are drawn from the Michigan Department of Community Health, Michigan Resident Death File, 2010; Importance of this measure. The percentage of an area’s population that dies before the age of 75 is indicative of deaths that might have been prevented. Examining the underlying reasons for “premature” deaths are likely to reveal community health issues that can be addressed and, if resolved, may lead to longer life among community residents. “Factors such as the percentages of adult smokers and adults with a college education are associated with premature mortality among U.S. counties. Population health policies aimed at reducing mortality disparities require an understanding of the socioeconomic context within which modifiable variables exist.” Cheng, Erika R., and David A. Kindig.
"Disparities in Premature Mortality Between
High- and Low-Income US Counties."
http://www.cdc.gov/pcd/issues/2012/11_0120.ht
m. Percentage of Deaths Before Age 75 (Premature Death), 2010
Michigan
56%
Tri‐County Lansing Area*
42%
Clinton County
39%
Eaton County
43%
Ingham County
44%
Gratiot County
42%
Ionia County
51%
Shiawassee County
44%
0%
10%
20%
30%
40%
50%
60%
* 2012 Community Health Profile and Health Needs Assessment. Healthy! Capital Counties. Source: Michigan Department of Community Health, Michigan Resident Death File, 2010; Ingham County Health Department. Across Michigan, 56 percent of the population dies before the age of 75. Within the six‐county SHS service area Ionia has the highest mark at 51 percent with a low of 39 percent for Clinton County. Using premature death as a singular surrogate for overall community health, each of the counties in the SHS service area exhibits a healthier status than generally found throughout the entire State of Michigan. 35 P
Cardiovascular Disease Measure. Deaths due to cardiovascular disease per 10,000 residents are used to represent the impact of chronic disease in the community. Data source & year. Data are from the Michigan Department of Community Health, Michigan Resident Death File, 2010; Importance of this measure. There is a strong correlation between cardiovascular disease and chronic morbidity (illness) and mortality (death). Cardiovascular disease includes coronary artery disease, stroke, cardiomyopathy, and heart failure. The highest rate of cardiovascular disease in the six‐county SHS service area is in Gratiot County. Shiawassee County is the second highest in the region with a rate close to the statewide average. All of the remaining counties in the region have rates lower than the statewide average with the lowest rate found in Eaton County. Deaths Due to Cardiovascular Disease per 10,000 Residents, 2010
Michigan
207
Area*
181
Clinton County
171
Eaton County
158
Ingham County
195
Gratiot County
249
Ionia County
182
Shiawassee County
209
0
100
200
300
* 2012 Community Health Profile and Health Needs Assessment. Healthy! Capital Counties.
Source: Michigan Department of Community Health, Michigan Resident
Death File, 2010.
Deaths per 100,000 Residents from Heart Disease, Males, by Race and Ethnicity: U.S., 2008
295.6
300
“Across Michigan, Black Men have the highest rates of cardiovascular disease deaths, followed by Black Women. White Males have a higher rate of mortality from cardiovascular disease than White Women.” Healthy! Capital Counties 2012 Community Health Profile & Health Needs Assessment, 47. 235.9
200
149.1
124.7
151.9
100
0
Black
American Asian/Pacific
Indian/Alaska Islander
Native
Hispanic
White, Non‐
Hispanic
National Center for Health Statistics. Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD. 2012 Table 30. 36 Sparrow Ionia Hospital | February 2013 Appendix P
Accidental Deaths 6‐County Region
35.3
Tri‐County Region
29.3
Clinton County
28.3
Eaton County
28.7
Ingham County
28.1
Gratiot County*
42.4
Ionia County
62.1
Shiawassee County
45.5
0
40
50
60
70
37.6
40
Male
Female
30
25
20
15
10
16.1
13.3
5
5
0
Large Metro Fringe
Source: CDC, Morbidity and Mortality Weekly Report. March 23, 2012 (volume 61, number 11; page 197. Source data may be found within the National Vital Statistics System. County‐level mortality file. http://www.cdc.gov/nchs/deaths.htm and http://wonder.cdc.gov/mortsql.html 30
Age‐Adjusted Motor Vehicle Death Rates per 100,000, 2007‐2009
Large Metro
Central
20
Source: Michigan Department of Community Health, Michigan Resident Death File, 2010; County Health Profiles. www.mdch.state.mi.us/pha/osr/chi/profiles/frame.html 35
The graph on the right is a comparison of the rates of death due to accidental injury from traffic related incidents in the U.S. between urban and rural localities. The trends found in the six county service area are similar to this national trend data. 10
Rural
The rate of death due to accidental injury is higher in Ionia and Shiawassee counties compared to both the statewide and the tri‐
county areas. 35.4
Town/City
(Micropolitan)
Michigan
Small Metro
Age‐Adjusted Death Rate Due to Accidental Injury per 100,000 Persons, 2010
Medium Metro
Measure. Deaths due to accidental injury per 10,000 persons include unintentional injuries such as traffic‐
related fatalities, falls, suffocation, drowning, and poisoning. The measure excludes deaths attributed to homicide or suicide. Data source & year. The data are reported on the Michigan Department of Community Health, Michigan Resident Death File, 2010. Importance of this measure. Accidental death due to poisoning and drowning are among the leading causes of death for children and young adults. Accidental death resulting from a fall is one of the leading causes of death among people 65 and over. According to the Healthy! Capital Counties Collaborative, poor socioeconomic environments can lead to an increase in deaths due to accidental injuries. 37 P
Community Health Assets ______________ Hospitals Sparrow Ionia Hospital. Ionia, Michigan General medical and surgical hospital Critical access hospital3 25 beds 524 admissions 51,303 outpatient visits 232 personnel Federally Qualified Health Clinics Both are located in Belding. Belding Health Center Belding Migrant Health Center Rural Health Clinics Charles R. Barker, Jr. DO Family Practice, PC (Belding) Family Health Center Portland (Portland) Ionia Family Practice (Ionia) Tony Balice Clinic (Ionia) 3
Critical Access Hospitals are typically located in rural areas, at least 35 miles from the nearest hospital,
and furnish 24-hour emergency care services 7 days a week. Critical Access Hospitals are limited to no more than
25 inpatient beds. Centers for Medicare & Medicaid Services (CMS). http://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/CertificationandComplianc/CAHs.html
39 P
Extended Care Facilities Two for‐profit nursing homes, 248 total beds Physicians and Nurses Table 2: Health Care Professionals
in the Sparrow Health System Service Area, 2008
Total, Active,
Non-Federal
Active
Medical
Nurse
Active Nurse
County
Doctors'
Anesthetists Practitioners
Clinton County
41
3
26
Eaton County
65
7
28
Ingham County
836
9
97
Ionia County
21
6
10
Gratiot County
48
4
10
Shiawassee County
45
9
13
1056
38
184
Area Total
Active
Certified
Nurse
Midwives
1
0
10
4
1
2
18
Total
Advanced
Practice
Nurses
30
35
116
20
15
24
240
Source: U.S. Department of Health & Human Resources, Health Resources and Services Administration, Area Resource
File, 2010.
Findings ______________________________ Socioeconomic Indicators The area served by Sparrow Ionia Hospital is not a prosperous community. Indicators associated with poverty are higher in this area than for the entire six‐county Sparrow Health System service area as well as for the entire state. Households that spend more than 30 percent of their income on housing costs are about average, but the area’s educational level—as indicated by the percentage of area residents with bachelor’s degree—is considerably lower than for the region or the state. Each of these indicators may relate to stress which can have negative impacts on health among area residents. Alternatively, the area is characterized by a very low violent crime rate which may reduce one potential source of stress that may be found more commonly in other locations. Indicator Location
Measure Comparison
Michigan 6‐County Region 19.0% 17.7% Ionia County 21.0% Michigan 6‐County Region 9.5% 9.4% Ionia County 10.8% Housing costs more than 30% of household income Michigan 6‐County Region Ionia County 34.8% 33.7% Violent crimes per 1,000 persons Michigan 6‐County Region Ionia County 489.9 270.6 Michigan 6‐County Region Ionia County 25.0% 25.2% Children in poverty Single parent families Adults with at least a Bachelor’s degree More favorable than the statewide average
About average
34.5% 156.6 13.1% Less favorable than the statewide average
41 P
Health Behaviors Indicators of healthy behaviors in the Sparrow Ionia Hospital service area are somewhat favorable in comparison to nearby areas and to the entire state. Smoking and drinking percentages among Ionia County residents are more favorable than average or about average. Data regarding obesity among young people, however, clearly reflects the observations of some community leaders who indicated that obesity is a major problem within this community. Indicator Location
Measure Comparison
Michigan 6‐County Region Ionia County 31.7% 26.7% Michigan 6‐County Region Ionia County 11.9% 14.4% Michigan 6‐County Region Ionia County 18.9% 21.6% Students who smoked in the past 30 days Michigan 6‐County Region Ionia County 14.0% 6.7% Binge drinking among adults Michigan 6‐County Region Ionia County 19.7% 17.8% Michigan 6‐County Region Ionia County 23.2% 12.8% Adults who are obese Children who are obese Adults who smoke Binge drinking among high school students More favorable than the statewide average
About average
30.7% 16.5% 15.4% 9.4% 15.8% 17.4% Less favorable than statewide average
Access to Care An important health care need in the Sparrow Ionia Hospital service area is access to primary care services. The percentage of persons lacking access to a primary care physician in the area is slightly greater than the percentage across the entire state, but as noted below, the population per primary care physician in the area is about 2.5 times the ratio for the six‐county region or the state. This implies long waits for primary care, at best, or serious difficulty getting primary care services at all for some area residents. Indicator Location
Persons per primary care physician Persons lacking access to a primary care physician Medicaid enrollment Adults reporting poor or fair health Adults reporting poor mental health More favorable than the statewide average
Michigan 6‐County Region Ionia County Measure Comparison
1,034 1,114 2,670 Michigan 6‐County Region 12.5% N.A. Ionia County 13.4% Michigan 6‐County Region Ionia County 12.3% 10.6% Michigan 6‐County Region Ionia County 14.2% 16.2% Michigan 10.7% 6‐County Region Ionia County 11.9% About average
10.8% 17.4% 14.0% Less favorable than the statewide average
43 P
Children’s Health Despite the issues related to accessing primary care services in Ionia County, early childhood indicators are very favorable. Both infant mortality and the incidence of low birth weight babies are lower than found elsewhere in the region or the state. In addition, although not illustrated below, 81 percent of children ages 19 to 35 months have received their recommended immunizations. This is the highest rate among the six counties served by Sparrow Health System, and is higher than the 75 percent rate for Michigan overall. Indicator Location
Infant deaths per 1,000 live births Low birth weight babies per 1,000 live births More favorable than the statewide average
Measure Comparison
Michigan 6‐County Region 7.5 5.9 Ionia County 3.9 Michigan 6‐County Region 82.8 75.3 Ionia County 65.7 About average
Heallth Outtcomess Morbidiity and morrtality data reported fo
or the Sparrrow Ionia H
Hospital serrvice area aare mainly b
better than the statewiide averagee. More fav
vorable ratees are reported for ambulattory‐sensitive hospitall admission
ns (e.g., adm
missions forr conditionss or events that are routiinely treateed in ambullatory settin
ngs), deathss before age 75, and deaths due tto heart atttacks or oth
her cardiova
ascular pro
oblems. On
n the other h
hand, death
hs due to accidentts—which a
are not the outcomes o
of health staatus or heallth care butt, rather, may be the ou
utcomes off risky perso
onal behaviior—are alm
most twice the rate in Ionia Coun
nty as for th
he entire Sta
ate of Michiigan. Indicator
Locatiion
M
Measure Compariison
Preventa
able hospitalizations p
per 10,000 reesidents Michigan M
6‐County Re
6
egion Io
onia Countty 268.4 NA Prematu
ure deaths ((before age 75) Michigan M
6‐County Re
6
egion Io
onia Countty 56% NA Michigan M
Deaths d
due to card
diovascular disease 6‐County Re
6
egion per 10,00
00 residents Io
onia Countty 207 NA Michigan M
6‐County Re
6
egion Io
onia Countty 35.4 NA Deaths d
due to accid
dental injurry per 10,000 reesidents More favorable
f
than the statewide average
a
About averagee
184.2 51% 182 62.2 Less ffavorable than statewide averrage
445 P
Sparro
ow Ionia Hosspital | Publicc Policy Assocciates, Inc. Appendix
Community Health Issues _______________ Based on the data reported in this report and the comments collected from key interviewees within the Ionia County community, the following are the most important health issues that are facing the community at this time: Healthy Life Styles. Obesity among adults and youth and the implications of these reflections of life style choices were among the most commonly identified community health problems. These issues are widely seen as part of a larger concern with healthy life style issues including poor eating habits, lack of exercise, alcohol consumption, tobacco use, and high levels of accidental deaths that may be associated with risky behavior, including drinking and driving. Access to Primary Care Services. While this issue is reported by interviewees to be somewhat alleviated by the Sparrow Ionia Hospital Emergency Department, the Federally Qualified Health Clinic (FQHC) in Belding, and several rural health clinics within the county, these clinics do not meet all of the primary health care needs of the entire community, according to feedback from interviewees. There is a clear need for more primary care providers to bring the ratio of residents to primary care physicians closer to statewide and regional levels, thus assuring more adequate urgent care and preventive health services. Chronic Diseases. Although the mortality rate from cardiac disease in this community is about average for the six‐county region and even lower than the statewide rate, several other indicators point towards the likelihood that chronic disease is an important concern in this community. Chief among them is the rate of premature deaths (e.g., deaths prior to age 75), preventable hospital admission due to diabetes, and relatively high rates of childhood and adult obesity. In addition, as one observer interviewed for this assessment stated, despite the availability of a few primary care clinics in this community, “there are a lot of people being attended to, but there are a lot of people that have illnesses that are not being treated.” Another interviewee claims that people with chronic illnesses are “getting pushed under the rug” or, at best, are referred elsewhere. 47 P
Appendix A: Methods __________________ In order to meet the needs of the community served by this hospital and to meet the requirements that are required by law, Sparrow Health System engaged in a two‐phase CHNA process beginning in 2011 and continuing through 2012. This process consisted of (1) participating as a supporting partner of the Healthy! Capital Counties’ (H!CC) region‐wide community health needs assessment, and (2) by supplementing the H!CC community health needs assessment and prioritization efforts with additional data collection, analysis, and identification of critical health care needs in the areas served by each of Sparrow Health System’s hospitals. Healthy! Capital Counties. H!CC is a collaborative effort of four acute care community hospital organizations and three area health departments that serve the Greater Lansing area, as defined by Clinton, Eaton, and Ingham counties, Michigan. The four hospital organizations are: Sparrow Health System, consisting of four community hospitals, three of which are located in the three‐county Greater Lansing region: Sparrow Hospital, Lansing, Michigan Sparrow Specialty Hospital, Lansing, Michigan Sparrow Clinton Hospital, St. Johns, Michigan Sparrow Ionia Hospital, Ionia, Michigan McLaren Greater Lansing Hayes Green Beach Memorial Hospital Eaton Rapids Medical Center The three health departments collaborating in this effort are: Ingham County Health Department, serving Ingham County, Michigan Barry‐Eaton District Health Department, serving Eaton County, Michigan Mid‐Michigan District Health Department, serving Clinton County, Michigan Additional support was provided by Physician’s Health Plan of Mid‐Michigan, McLaren Health Plan, Ingham Health Plan Corporation, and the National Association of County and City Health Officials. A‐1 P
As a partner of the Healthy! Capital Counties collaborative, Sparrow Health System participated as a member of the Steering Team that was directly responsible for overseeing the CHNA conducted within the three‐county region as well as for community dialogues conducted by H!CC to identify the greatest health care needs in the region, prioritize these needs, and incorporate them into a region‐wide (e.g., Clinton, Eaton, and Ingham counties) Community Health Improvement Plan (CHIP). Under the direct supervision of the health officers within each of the three community health departments, the H!CC CHNA was compiled from publicly‐available data resources obtained from the U.S. Bureau of the Census (American Community Survey), Michigan Department of Community Health (vital records and registries), Michigan State Police (crime statistics), Centers for Disease Control and Prevention (Behavioral Risk Factor Surveillance Survey), and the Michigan Department of Education (Michigan Profile for Healthy Youth), among others. These data were supplemented by nine focus groups conducted with Lansing area residents (including one conducted in Spanish) who may be considered medically underserved or, at a minimum, may have greater than average health care needs. These individuals consisted of adults without health insurance, those enrolled in Medicaid, unemployed residents, handicapped residents, and low‐wage workers. Data collected through these efforts were compiled in a region‐wide report that was used as the basis for a series of public community dialogues in which the findings were discussed and participants were asked to assist the professional staff in identifying the area’s most important health care needs. These needs were prioritized at a subsequent community meeting. The Collaborative’s region‐wide health improvement plan will be based on these determinations and the interests of each partner—hospitals, health departments, and others, alike—to work towards ameliorating the high priority issues. Sparrow Health System. As Sparrow Health System serves all or parts of six counties, including the three‐county Greater Lansing area, it was determined by its Executive Leadership that their participation in the Healthy! Capital Counties collaborative would need to be supplemented with additional data collection efforts in order to include these additional areas—such as the community served by Sparrow Ionia Hospital—in their assessment, and because there were some additional service area populations and issues which were not directly addressed in the H!CC assessment process. In response to this need for additional information, Sparrow Health System hired Public Policy Associates, Inc., to work with the H!CC team on their foundational community health needs assessment and to collect additional data to meet the health system’s additional information needs. A‐2 Sparrow Ionia Hospital | February 2013 Appendix P
Through these efforts, the following tasks were accomplished. 1. Professional Community Health Expertise. By participating collaboratively with H!CC, the foundation for the Sparrow Health System Community Health Needs Assessments was based on the professional expertise and direction of the Health Officers and technical staff of each of the participating health departments: Renee Branch Canady, Ph.D., Health Officer, Ingham County Health Department, Lansing, Michigan Colette Scrimger, Health Officer, Barry‐Eaton District Health Department, Hastings, Michigan Marcus Cheatham, Health Officer, Mid‐Michigan District Health Department, Stanton, Michigan In addition, Lisa McCafferty, the Health Officer for the Ionia County Health Department, and Robert Lathers, the Chief Executive Officer of Ionia County Community Mental Health Services, were consulted for the Ionia County assessment. 2. Quantitative Data Collection. Much of the quantitative information contained in this report are drawn from the same resources found in the H!CC CHNA report, and most of these data were supplied by the Ingham County Health Department to Sparrow Health System through Sparrow’s participation in this collaborative. In a few cases, data were updated to reflect the availability of more recent data. In addition, Sparrow Health System’s consultants compiled some additional data elements for this assessment. Additional data elements include the following: Single parent households. Bureau of the Census, American Community Survey, 2006‐2010; Medicaid enrollment. Michigan Department of Community Health, 2012; Health insurance coverage (population without health insurance). Bureau of the Census, Small Area Health Insurance Estimates, 2009. Low birth weight babies. Michigan Department of Community Health, 2000‐
2010. 3. Qualitative Data Collection. In order to reach a broad cross‐section of the hospitals’ service areas and in order to investigate the heath care needs and concerns of identifiable sub‐groups within the region’s population, Sparrow Health System A‐3 P
sponsored 39 one‐on‐one interviews and six focus groups as part of this assessment. Interviews were conducted in person or by telephone and typically took 45 to 60 minutes. Focus groups were scheduled for 90 minutes each; some exceeded that length of time. Interviews and focus groups were conducted between June 2012 and November 2012. Interviewees and focus group participants were mainly health care consumers who have health care insurance and who serve in their respective communities as health care leaders, elected officials, health care providers, social service workers, educators, retirees, and others, as noted below. All interviews were conducted by Public Policy Associates, Inc. staff. Interviewees included residents of each county in which a Sparrow Health System hospital is located, including Ionia County. Please note that approximately 15 percent of all interviewees were located within Ionia County, and none of the Ionia County interviewees were members of the minority groups listed below due to the relatively low proportion of minorities in this county (with the exception of prison inmates whose health care needs are overwhelmingly provided within the prison system or elsewhere). Approximately twenty‐five percent of all participants who participated in these data collection efforts are members of racial or ethnic minority groups. Racial, ethnic, and religious minority interests represented include the following: Muslim Community focus group African American focus group Medical director of an Hispanic Community organization Representatives of the East Indian Community International students from China, Taiwan, and Egypt Other community participants include the following: Community health leaders, including health care administrators and hospital board members Health care providers, including physicians, other service providers, and long‐
term care providers Educators, including one health care educator Social service providers Refugee service providers A‐4 Sparrow Ionia Hospital | February 2013 Appendix P
State and local elected officials Students Retirees All interviewees and focus group participants were explicitly asked to identify the most pressing community health needs as well as their suggestions for addressing these issues. Identification of the most frequently mentioned community health needs for each hospital’s service area were combined with the findings illustrated through analysis of community health indicators to compile the findings in this report. 4. Follow‐Up/Community Health Priorities. A key follow‐up effort has been to identify how the high priority community health needs that have been identified independently through each process relate to each other, and how they collectively represent the basis upon which the most important health needs in the Sparrow Health System service area and the H!CC three‐county region will be addressed. At the time this report was completed, an illustration of the commonalities between the two sets of priorities was prepared and circulated to all of the hospitals and health departments participating in this collaborative effort for their planning activities. A‐5 P
Appendix P
Appendix B: Interview and Focus Group Participants ____________________________ As a supplement to the Healthy! Capital Counties (H!CC) Community Health Needs Assessment (CHNA), interviewees and focus group participants were solicited from a wide variety of community residents within the six main counties served by Sparrow Health System hospitals. Among those solicited were community leaders and health care leaders; state and local elected officials; physicians and other health care providers or workers; leaders and members of racial, ethnic, and religious minorities; educators; students; retirees; social service providers; and others. Minority group members with whom these issues were discussed include African Americans, members of the Muslim community from several different ethnic backgrounds, international students, and members of the East Indian community. Health care issues within the Hispanic community were addressed by a physician that serves the Hispanic community. International students were from China and the Middle East. The occupations or special expertise of these participants not only include expected participants such as city managers, health care administrators, and social service providers, but they also include a fitness coach, two dentists, a farmer, a former drug addict, a firefighter, a high school principal, a veterinarian, and a librarian. Almost 70 individuals participated either as interviewees or focus group participants for this project. The categories in which these individuals are classified are found in Table B‐1, below. Note that some individuals are classified in more than one category. Also note that only a subset of these individuals were interviewed with specific reference to Sparrow Ionia Hospital and the Ionia County service area. Table B-1: Interviewees and Focus Group Members, 2012
Category
Number
Community Leader
Educator
Government Official
Health Care Administrator
Health Care Consumer (not otherwise categorized)
Health Care Provider/Health Care Worker
Hospital Board Member
Long-Term Care Provider
Minority Community Leader
15
6
8
7
6
10
11
4
5
B‐1 P
Table B-1: Interviewees and Focus Group Members, 2012
Category
Minority Community Member
Physician
Refugee Services
Religious Leader
Religious Minority Member
Retiree
Social Services Provider
Student
Total*
Number
15
4
2
1
8
4
9
3
118
* Some individuals are in more than one category. B‐2 Sparrow Ionia Hospital | February 2013 Appendix P
Dolly Parton’s Imagination Library 2012 Survey Results
Total Number of children enrolled in the DPIL program
1539
Total number of families surveyed
(some families have more than one child enrolled)
924
Percentage of families that responded to survey
31%
Percentage of respondents enrolled one year or greater
63%
Percentage of respondents enrolled more than 6 months, but less than one year
23%
Percentage of respondents enrolled less than 6 months
14%
Percentage of respondents that reported their child is bringing the books
to them and requesting them to read to them
90%
Percentage of respondents that have reported their children are spending
time looking at books on their own.
93%
Percentage of respondents that reported they are reading more to
their children then they did before
86%
Percentage of respondents that reported they have logged on to the website to
use the book activity resources that are available
7%
Percentage of respondents that reported they would not be able to still participate in
The program if funding from community donations was NOT available
58%
Appendix Q
Appendix R
Appendix R
Appendix R