Assessing Children's Health in Dallas County 2011

2011 2011 beyond beyond a b c a

b Assessing Children’s Health in Dallas County c Assessing Children’s Health in Dallas County Contents

About Children’s Medical Center 5

Summary 6

Recommendations 14

Demographic Snapshot 15

61 Indicators 17

Research Methodology 82

Recent Studies On Children’s Issues 83

How You Can Help 84

Key Websites 85

“Beyond ABC” Online 86

MyChildren’s 87

Real Children’s Stories

Zach Guillot 16

Brianna Lamar 24

Annabella Spears 40

Vaughn Washington 64

Daniel Stiegler 78 hildren’s Medical Center is pleased to present the c 2011 edition of Beyond ABC: Assessing Children’s Health, a comprehensive report on the quality of life for children in Dallas County. Texas has the highest rate of uninsured children in the United States, and this new report finds that of the 654,263 children under age 18 in our county, more than 29 percent live in poverty. More than a quarter of a million children living in Dallas County are on Medicaid, and 17.9 percent of the county’s children have no health insurance at all. Here at Children’s, we are so committed to serving children that we provide almost $50 million annually in verified charity care. We believe we have a sacred trust to serve every child who comes through our doors – including the four out of seven who need financial assistance of some kind. We believe that the health of our children as a vital community issue. In recent years, the six MyChildren’s Pediatric Practices that we have opened in the Dallas area have created medical homes providing primary care and preventive services for thousands of children in under- served neighborhoods. Our goal is to make life better for all children, because we see healthy childhood as an essential investment in the future for Dallas, for Texas and for our nation. For nearly a century, it has been our privilege to bring children the gift of good healthcare through the wide range of medical and dental services we offer at Children’s, a private, not-for-profit institution that receives no county tax dollars. We are the seventh-largest pediatric hospital in the nation as well as one of the most acclaimed — widely recognized for our 54 subspecialties and our ability to treat the most specialized of cases. We diagnose and treat one quarter of all the pediatric cancer cases in Texas, and we are a major center for organ and bone-marrow transplants, cardiac surgery, blood disorders and orthopedics. Children’s also was the first designated Level I pediatric trauma center in Texas, and it is the primary pediatric teaching facility for the University of Texas Southwestern Medical Center, the top medical school in the region. Please read the Beyond ABC 2011 report, consider its recommendations and join us in this vital mission. Together, you and Children’s Medical Center can work to create a healthier, safer world for all of our children.

Christopher J. Durovich President and Chief Executive Officer Children’s Medical Center hildren’s Medical Center se complace en presentar c la edición 2011 de Beyond ABC: Assessing Children’s Health (Más allá del ABC, una evaluación de la salud de los niños), un completo informe sobre la calidad de vida de los niños del condado de Dallas. Texas tiene la tasa más grande de niños sin seguro de los Estados Unidos. Este nuevo informe muestra que más del 29 % de los 654,263 niños menores de 18 años del condado vive en la pobreza. Más de un cuarto de millón de niños que viven en el condado de Dallas es beneficiario de Medicaid. Y un 17.9 % de los niños del condado no tiene ningún tipo de seguro de salud. En Children’s, nos comprometemos de tal manera a brindar servicios a los niños que donamos casi $50 millones por año para este fin. Creemos que tenemos el sagrado deber de prestar servicios a todos los niños que llegan a nuestro centro, incluidos los cuatro de siete que necesitan ayuda económica. Consideramos que la salud de nuestros niños es un asunto vital para la comunidad. En los últimos años, los seis centros pediátricos “MyChildren's” que hemos inaugurado en el área de Dallas se han convertido en hogares médicos que prestan servicios de atención primaria y preventiva a miles de niños de vecindarios marginados. Nuestro objetivo es mejorar la vida de todos los niños, porque consideramos que una infancia saludable es una inversión esencial para el futuro de Dallas, de Texas y de nuestro país. Durante casi un siglo, hemos tenido el privilegio de ofrecer una buena atención de salud a los niños mediante la gran variedad de servicios médicos y dentales que ofrecemos en Children's, una institución privada sin fines de lucro que no recibe fondos de los impuestos del condado. Somos el séptimo hospital pediátrico más grande del país y uno de los más reconocidos, sobre todo por nuestras 54 subespecialidades y nuestra capacidad para tratar los casos más excepcionales. Diagnosticamos y tratamos la cuarta parte de los casos de cáncer pediátrico de Texas. Somos un importante centro de trasplantes de órganos y médula ósea, cirugía cardíaca, atención de trastornos sanguíneos y ortopedia. Además, Children’s fue el primer hospital de Texas designado centro de trauma pediátrico de nivel I, y es el centro de enseñanza de atención pediátrica primaria del Southwestern Medical Center de la Universidad de Texas, la mejor facultad de medicina de la región. Lea el informe Beyond ABC 2011, tenga en cuenta sus recomendaciones y acompáñenos en esta importante misión. Juntos, usted y Children’s Medical Center pueden lograr un mundo más saludable y seguro para todos nuestros niños.

Christopher J. Durovich Presidente y Director Ejecutivo Children’s Medical Center 2011 beyond a b c

Assessing Children’s Health in Dallas County

PUBLISHED BY EDITORS DATA COLLECTION We gratefully acknowledge Children ASSISTANCE At Risk for allowing the use of the Joyce Sáenz Harris original methodology of its Growing University of Texas at Dallas, Jane M. Hogan Up in Houston report. Institute for Urban Policy The Advisory Board for Research We encourage widespread use of Beyond ABC: Assessing this information. Permission to use Dr. Timothy M. Bray, Director Children’s Health in any part of this document is granted, Dallas County Rubana Ahmed, Research provided that all written uses give Associate credit to Children’s Medical Center.

DESIGN Robert C. Chalwell Jr., Research Associate FIND US ON THE WEB Anne Humes AHHA Graphics Danny Pacheco, Research See this and previous years’ Associate Beyond ABC reports at Anthony Galvan, Senior http://www.child rens.com/about-us/ Research Associate leading-the-way/child-advocacy/ beyond-abc.aspx Acknowledgments

The Advisory Board for Beyond ABC 2011: Assessing Children’s Health in Dallas County

Diana Aguirre Tai Ho Lori Palmer Big Brothers Big Sisters Lone Star Legal Aid of NorthWest Texas Girls Inc.

Richard Amory Kay L. Hopper Vonetta Pelts North Texas Food Bank The Warren Center The Turn Around Agenda

Natasha Anderson Benjamin Jones Maria Pintor Children’s Medical Center Audubon Texas Wesley-Rankin Community Center

Suzy Armstrong Nickey Miller Jones Patrice Powell LaunchAbility Walmart Health & Wellness The Turn Around Agenda Division Syl Benenson Lisa Oglesby Rocha National Council of Jewish Women Jan Edgar Langbein AVA NCE-Dallas Genesis Women’s Shelter Petrella Booker Bea Salazar Dallas Bethlehem Center Libbie Lee Bea’s Kids Community Volunteer Lauren Church Ray de los Santos American Heart Association, Robin R. Lee LNESC Dallas Dallas Division Spina Bifida Association of North Marilyn Self Texas Summer Collins Community Council of Greater Dallas Fort Worth Hospital Demetria McCain Dallas Council Foundation Inclusive Communities Project Laura Steves, Ph.D. Evelyn Costolo Madeline McClure Asthma & Allergy Foundation of Wipe Out Kids’ Cancer TexProtects: The Texas Association America, Texas Chapter for the Protection of Children Brenda Daniels Zachary S. Thompson Daniels’ Healthcare Consulting Paige McDaniel Dallas County Health & Human Community Partners of Dallas Services Valentina Doyon National Association of Dental Janie Metzinger Catarina Torres Plans Mental Health America of Greater Catholic Charities of Dallas Dallas Robert Eilers Dr. Ray Tsai The Arc of Dallas Lori Millner, Ph.D. Children’s Medical Center DFW Area Health Education Center Alina Esquivel Allen Vaught Independent Mental Health Alfreda B. Norman Baron & Budd, PC Counselor, Cedar Hill, TX Federal Reserve Bank of Dallas Connie S. Wilson, Ph.D. Sue Gainer Jeanne O’Neill Dallas Independent School District ChildCareGroup Frito-Lay Ci ndy Wright Vance Gilmore Joanne Osterland Rainbow Days Inc. Camp John Marc The Family Place

Fred Guerra Dallas Regional Chamber of Commerce The “Real Children’s Stories” found throughout this report were made Marilyn Herrick possible through the generosity of Zach Guillot, Brianna Lamar, Annabella March of Dimes, Texas Chapter, Spears, Daniel Stiegler, Vaughn Washington, and their families. Dallas Division

4 About Children’s Medical Center of Dallas

For nearly a century, Children’s Medical Center of DISTINCTION Dallas has earned its stellar reputation as one of • Children’s, which is a private, not-for-profit hospital, the finest pediatric healthcare providers in the is among only 6 percent of the nation’s hospitals to United States by fulfilling its mission to make life be named a Magnet Recognition Program by the better for children. American Nurses Credentialing Center. Child advocacy is a vital part of our mission as we • Children’s was the first designated Level I Trauma continually work to educate officials and the public. Center for pediatrics in Texas. Advocacy efforts extend into the areas of children’s health insurance (Medicaid and CHIP), child abuse, • As the primary pediatric teaching facility for UT pediatric AIDS, childhood obesity, immunizations and Southwestern Medical Center, the top medical school community health. Children’s also leads the Safe Kids in the region, Children’s hosts research conducted Dallas Area Coalition, spearheading local efforts to by its medical staff members that is instrumental raise awareness about childhood injury prevention. in developing treatments, therapies and a greater understanding of pediatric diseases.

RECOGNITION • Children’s is one of only 14 national pediatric research centers sanctioned by the National Institutes. • Children’s has been ranked among the top pediatric hospitals in the country by U.S. News & World Report.

• The only pediatric hospital in the nation with seven SERVICES disease-specific management program certifications • Children’s is licensed for 559 inpatient beds at two by The Joint Commission: Asthma Management campuses, including 487 beds at its main campus in Program; Autism Evaluation and Diagnostic Program; the Southwestern Medical District and 72 beds at Diabetes Education Program; Eating Disorders Children’s at Legacy in Plano. Program; Comprehensive Epilepsy Program; Fetal Heart Program; and The Pediatric Pain Management Center. • Children’s has 54 subspecialties and serves children through more than 570,000 patient visits each year. • In 2011, Hospital and Health Networks magazine named Children’s as a “Most Wired” hospital for • Children’s has 71 dedicated pediatric intens ive-care the seventh time. unit beds, making it one of Texas’ largest ICUs just for children. • Children’s Medical Center was selected by Becker’s Hospital Review as one of its “100 Best Places to • Children’s features 28 of the largest, most techno- Work in Healthcare” in 2011. logically advanced operating rooms available in pediatrics today.

• Children’s boasts the largest heart center for children in North Texas, and the only pediatric heart center with a 21-bed dedicated pediatric cardiovascular ICU.

• Children’s operates a nationally renowned pedia tric regional transport services team with accreditation in three modes of transportation: ground ambu- lance, helicopter and jet.

• Children’s is a major pediatric kidney, liver, heart, intestinal and bone-marrow transplant center.

• Children’s specialty centers are among the largest in the country, including centers for cancer, sickle cell and cystic fibrosis patients.

5 Access to healthcare is directly linked to a child’s health and well-being.

Summary Change isn’t just coming to Dallas County: Change is already here. In fact, change has been making itself manifest for the past 30 years. For Dallas County, this becomes apparent from viewing an online 2010 U.S. Census study, breaking the North Texas area down into census tracts. Zoom in for a close look, and you can map Dallas neighborhoods by a patchwork of race and ethnicity. Pull back for a look at the county as a whole, however, and you’ll see a distinct line slashing across Dallas County nearly on the diagonal, from northwest to south- east. This dividing line, not coincidentally, follows the path of the Trinity River.

6 There is no more critical priority for the Dallas community than preparing our children for a healthy, successful Thousands of children and productive future. never visit a dentist.

Dallas County Children Living in Poverty

192,502 children live below the poverty line

he wedge of Dallas County to the northeast has a popu- Tlation that is 40.4 percent white, 36.7 percent Hispanic, 16.2 percent black and 4.9 percent Asian, for a total population of 1,455,973. parents, the military, the teachers and policemen, the entrepreneurs The wedge of Dallas County to the and corporate executives who some- southwest, meanwhile, is 40.8 per- day will take the place of Gen X and cent Hispanic, 31 percent black, 21.5 the Millennials in our society. percent white and 5.1 percent Asian, for a total population of 912,166. These kids also will be our city- council members, state legislators These numbers forecast our future, and congressional leaders. By which is mirrored in every other 2056, the children of today — the major metropolitan area of the state. ones born in the 21st century — The Hispanic population is growing will be running the nation. One of faster than any other. Among Texas them, perhaps a Texas boy or girl children ages 17 and younger, the who is only 10 or 11 years old right census counted 3,317,777 Hispanics now, could even be in the White in 2010, or 48.3 percent of this House as Commander in Chief. age group. The number of Hispanic But now that we’ve looked decades children in Texas grew 39 percent ahead, let’s look at today — at over the decade. 2011. Let’s view the near future of These are the adults of tomorrow — 2012. There are 654,263 children the face of the Texas workforce of and teens living in Dallas County. the year 2036. Twenty-five years What are we providing for them from now, they’ll be the taxpayers now, in the way of health, educa- whose wage deductions will fund tion, economic security and safety? the aging baby-boom generation’s Social Security checks. They’ll be the

7 n Dallas County, we are giving The result: At Children’s Medical about 192,502 children live below children up to 40 days a year Center alone, we see 135,000 visits the poverty line — enough to fill Iof unhealthy air quality, due to to the Emergency Department every Cowboys Stadium more than twice ozone in the air they breathe. The year, many of them for non-emer- over. Tens of thousands more Dallas result: an asthma epidemic among gencies. They come to Children’s County children live just above children of all income levels. because there is nowhere else they poverty level, in families that can be can go, and because we never turn best classified as “the working poor.” Almost 18 percent of Dallas County away a child in need of treatment, children are without health insur- Hunger is a fact of life here: About regardless of the family’s ability ance — and that is actually an 28 percent of Dallas County children to pay. improvement over previous years. — more than 183,000 — suffer More than a quarter of a million In Dallas County, 29.4 percent of our from food insecurity and inade- Dallas County children are on children live in poverty, defined in quate nutrition. Seven out of every Medicaid; nearly 60,0 00 are on 2011 as an income of less than 10 public school children in Dallas the Children’s Health Insurance $22,350 for a family of two adults County are eligible for free and Plan (CHIP). and two children. That means that reduced-price meals.

Aren’t there publicly funded assistance programs for these children and their families? Yes, there are. Dallas County But you would be hard-pressed to find a single public program that The wedge of Dallas County to the northeast of the Trinity actually serves all the children who River has a population that is 40.4 percent white, 36.7 desperately need help, or to find a percent Hispanic, 16.2 percent black and 4.9 percent Asian, public program that is not being for a total population of 1,455,973. trimmed in the political throes of Texas’ latest budget crisis. The wedge of Dallas County to the southwest, meanwhile, is 40.8 percent Hispanic, 31 percent black, 21.5 percent Remember those 135,000 visits to white and 5.1 percent Asian, for a total population of Children’s Emergency Department? 912,166. Many children come to the Emergency Department not for true emergencies, but for basic ailments such as colds, coughs and pink eye

Coppell Carrollton (conjunctivitis). The reason so many Richardson of those visits are for non-emergen- Farmers Branch cies is a simple one: the roughly Garland Rowlett 117,700 Dallas County children University Park without health insurance, the Highland Park nearly 60,000 youngsters on CHIP Irving and the 257,315 children on Medicaid, who don’t have a true Dallas Mesquite medical home.

Grand Prairie

Trinity River

Duncanville

DeSoto

8 There are 654,263 children and teens living in Dallas County.

Thousands of children also come to Our children are Children’s for true medical emergen- getting both cies or for the world-class pediatric more overweight care that only we, with our 54 sub- and more specialties, can provide in Dallas malnourished. County. Saddest of all are the emergencies involving abused or Our children, paradoxically, are neglected children, who are 37 per- getting both more overweight and cent of the deaths at our hospital. Texas’ budget cuts will likely have more malnourished. According to a disproportionate effect on chil- FeedingAmerica.org, vast sections That is the reality we at Children’s dren’s hospitals, which treat the of southern and western Dallas see every single day. That is the state’s youngest and poorest County are “food deserts,” lacking reality of why we annually provide patients. The financial implications in neighborhood supermarkets that almost $50 million in verified char- will not mean halting operations or supply healthy foods. While school ity care. That also is the reality of necessarily curbing patient care, athletic programs continue to be serving as the safety-net pediatric children’s hospital advocates say. supported, physical education and hospital for Dallas County without But it will mean cutting back on fitness programs for the general receiving any county tax dollars. expansions needed to serve a student population have been cut. Here is another reality: Texas rapidly growing population of Children of all income levels spend Medicaid is estimated to be $5 children, and it will affect our abil- more time being sedentary, watch- billion short in projected state ity to recruit and retain the best ing TV or playing video games funding levels for 2012-13. What pediatric specialists and faculty. rather than engaging in physical does that mean for the children activities that would help build Those are disturbing facts. of Dallas County? healthy bodies and minds. Now think about these: Children near or below the poverty Education should be the key to line will be hit hardest, because escaping poverty, and historically, fewer physicians than ever will it has been exactly that. But Dallas accept Medicaid patients. (Only County’s poor children attend pub- Overweight or Obese 42 percent of Texas doctors cur- lic schools that too often are in Dallas County Children rently accept them.) Most private disrepair, overcrowded and chroni- dentists already do not accept cally underfunded. In the past Medicaid patients. decade, Texas schools have lost $500 to $700 per student per year, Children who are lucky enough according to former Texas state to have private health insurance demographer Steve Murdock, and will be affected, too. There will One third of the state’s school system has had be even bigger crowds and longer high-schoolers are to absorb about 150,000 new stu- wait ing times in emergency rooms, estimated to be overweight or obese. dents without any new funding. and private insurance rates will go up for everyone.

9 Our Beyond ABC advisory board individual — perhaps a parent, members who work in social wel- family member, caregiver, teacher, fare tell us that they see too many clergy person, counselor, nurse, Dallas County children who live doctor or social worker — can with domestic uncertainty on a make a life-changing difference for daily basis. These children do not a child or teenager. We hope that know when they will eat, where each of you, like each of us here they will sleep, or who — if any- at Children’s Medical Center, will one — will care for them after become an advocate and commit school. They inhabit a world that to the mission of making life bet- is impoverished, unpredictable, ter for all children. noisy, violent, polluted and down- The Beyond ABC report’s 2011 find- right scary — a wor ld that spares ings, compiled by the University of too little thought for the welfare Texas at Dallas’ Institute for Urban of “somebody else’s children.” Policy Research, revealed several For these children, the system is pressing areas of concern in regard permanently broken. It is no won- to the welfare of Dallas County’s der that they might feel forgotten children. The following issues were and marginalized, that they might identified as having particular become discouraged and reach urgency by the report’s citizen adulthood having given up on the advisory board. possibility of success. Joyce Sáenz Harris, Editor We must remember that when Communications & Policy Manager institutions and governments fall Community Relations short of the ideal, even a single Children’s Medical Center

We must remember that when institutions and governments fall short of the ideal, even a single individual — perhaps a parent, family member, caregiver, teacher, clergy person, counselor, nurse, doctor or social worker — can make a life-changing difference for a child or teenager.

10 he most pressing issues facing Dallas County’s Tchildren can be best articulated against a backdrop of changing economic and demographic conditions, which have led to changes in childhood health, education and safety outcomes.

11 he most pressing issues facing Dallas County’s children Tcan be best articulated against a backdrop of changing Overall, economic and demographic conditions, which have led to changes in the county’s childhood health, education and population grew safety outcomes. by just over 6 percent from looks decidedly different in 2010 Economic Security 2000 to 2010. than it did in 2000. As has been the case for several years, residents continue to experi- Moreover the percentage of families ence the troubles associated with of 17.9 percent of children uninsured living below poverty from 2000 the global recession. Dallas County is is more than double the rate of 8.0 through 2009 increased from 10.6 not unique in this sense, as similar percent estimated for the nation. percent to 14.2 percent, while the experiences have been shared by the percentage of the population speak- residents of urban counties through- Demographic Shift ing a language other than English out the nation. The impact, however, The continued issues of economic at home rose from 32.5 percent to is particularly severe for those with security are coupled with significant 39.3 percent. These shifts have children. Economic security has been demographic shifts in the county’s important bearing on the nature of shown, time and time again, to be population. Overall, the county’s pop- services that the county’s children the gateway to educational opportu- ulation grew by just over 6 percent will need and the manners and nities and stable health. from 2000 to 2010. However, the mechanisms by which they are delivered. Moreover, the shifts that Dallas In the first decade of the 21st demographic picture of the county’s County has experienced to date century, the percentage of Dallas population shifted meaningfully. are suggested by many to be bell- County’s children living in poverty While the county’s non-Hispanic wethers of the changes to occur in increased by more than 10 percent- population declined by 2.1 percent, the coming decades. It is crucial that age points — from 19.2 percent the county’s Hispanic population, its organizations seeking to secure the in 2000 to 29.4 percent in 2010. fastest growing segment, grew by health of Dallas County’s children Moreover, with the increase in 36.7 percent. Other racial groups adequately prepare for this future Dallas County’s population, this per- grew by double digits as well, with shift by identifying new and innova- centage change equates to 69,564 the county’s Asian population grow- tive ways to embrace change and more impoverished children today ing by 34.9 percent and the county’s offer culturally competent solutions. than were here just 10 years ago. African-American population growing Not surprisingly, this increase in the by 17.2 percent. The resulting racial The table below depicts the shift- number of economically disadvan- and ethnic makeup of Dallas County ing balance in population. taged children has ramifications in many other areas. Over the same 10-year period, the percentage of Percentage of Population by Race in Dallas County — 2000-2010 Dallas County public school children Source: US Census of Population and Housing, 2000, 2010 eligible for free- and reduced-price lunches has jumped from 50.3 per- 60% cent in 2000 to 66.9 percent in 2000 2009. By 2011, that number had 50% 2010

reached 70.9 percent of children — 40% meaning that 7 out of every 10 public school children are eligible 30% for free and reduced-price meals. 20%

While Dallas County has seen a 10% significant and steady decline in 0% the percentage of children without White African-American Asian Other health insurance, its 2010 estimate

12 Access to Care Child Abuse and Neglect but actual student performance Children who are insured are more In 2010, there were 5,591 confirmed has been clouded by administrative likely to have a medical home or cases of child abuse or neglect in and institutional changes. an otherwise consistent source of Dallas County. While this number is Standardized test scores steadily medical care to receive preventa- slightly down from 2009 and fairly rose from 2000—2002, but the tive checkups, immunizations, and representative of the past five years, implementation of the TAKS test in proper medications. Thus, the it actually is a 39 percent increase 2003 was met with a sharp decline access to healthcare afforded by since 2000. in performance. However, since some form of health insurance is Over the same time period, 210 2005, performance has, again, directly linked to a child’s health children have died as a result of steadily increased. Beginning with and well-being. child abuse or neglect, 17 of them the 2011-12 academic year, Texas Although Texas and Dallas County in 2010. From 2002 to 2008, again will adopt a new standardized continue to have some of the high- domestic-abuse shelters have test, the State of Texas Assessments est uninsured rates for children se rved a combined average of of Academic Readiness (STAAR). around the nation, there has been 1,526 displaced children per year. Moving forward, it will be important some marked improvement. Over to note if the new assessment tool During this time period, the Texas the past five years, the percentage is accompanied by a distinct change Legislature increased funding for the of children in Dallas County within student performance similar to child-abuse report intake system and out health insurance has declined that of 2003. expanded middle- and high-school by nearly 8 percent, from 25.8 health curriculum to include parent- In addition to inconsistent percent to 17.9 percent. Over the ing skills and child abuse prevention. standardized testing, the Texas same time period, CHIP enroll- Education Agency also ended the ment has increased by more than Still, children who are exposed to Texas Projection Measure (TPM), 20,000, and Medicaid has added violence can experience significant more than 80,000 enrolled children emotional trauma, in addition to in Dallas County. physical abuse and neglect. Furthermore, changing demographics Although t hese trends indicate a mean that language and culture bar- What are we relative increase in access to care, riers often exacerbate the difficulties Dallas County continues to trail providing our kids of navigating the legal, medical, and much of the nation in this respect, social support systems that are so in the way of and the ability to continue with necessary for children and families similar progress remains unclear. health, education, who experience abuse or neglect. The likelihood of federal and state economic security budget cuts could limit future Measuring Educational Success increases in coverage from CHIP Over the past 10 years, Dallas County and safety? and Medicaid. Uncertainty sur- has seen considerable fluctuation rounding the future of healthcare in standardized test performance, reform further complicates potential changes to the availability of which awarded “exemplary” status insurance, public or private. to some schools based on projec- tions of student success. Since the discontinuation of this measure, the state has seen a drastic increase in the number of academically unacceptable schools. The frequent changes made to assessment practices at both the student and school levels have complicated any ability to measure the success of Dallas County schools.

13 Recommendations The citizen advisory board for “Beyond ABC 2011: Assessing Children’s Health in Dallas County” identified the following recommendations.

• Enhance the infrastructure • Improve the air quality in • Provide adequate resources for public health and support Dallas County. and staffing for Child Protective national health reform to guar- Services. • Work to eliminate “food antee access to healthcare and deserts” in southern and • Expand affordable daycare, coverage for all children from western Dallas County. including after-school and birth to age 21. summer childcare options. • Increase immunization efforts. • Ensure that Texas Medicaid and • Support local schools and CHIP systems work effectively • Support efforts that assist those teachers as they cope with for children and their families. affected by family violence budget crises. • Increase reimbursement rates • Invest in programs to help pre- • Mobilize faith groups, civic to primary-care providers who vent child abuse and neglect. leaders, volunteers and commu- accept Medicaid or CHIP. • Mobilize against bullying in nity organizations to assist • Fund graduate medical educa- Dallas County schools. low-income families. tion, especially for pediatric • Increase the availability of training. safe, affordable housing.

14 Demographic Snapshot The region’s youth by race, ethnicity, and poverty status

21.62%

8.57%

46.42%

23.34%

White Youth Population African-American Youth Population (including Hispanics) Asian Youth Population Other Single Race Youth Population

ccording to final U.S. Census to 29 percent of the total population 2010 reports, 654,263 children under the age of 18; in the city of A under the age of 18 live in Dallas Dallas, 37 percent of all children lived County, making up approximately 28 below the poverty line. percent of the county’s total population. Poverty was experienced differently In terms of race, 46 percent of the county’s by youth of different races. Only 1 out children were white, including Hispanics, of every 12 white, non-Hispanic children followed by 23 percent African-American. (8 percent) in Dallas County were living By ethnicity, a slight majority of children in below the poverty level, while one in Dallas County (51 percent) were Hispanic; three Hispanic children (34 percent) this indicates a significant upward trend in lived in poverty. For African-American the Hispanic population, since Hispanics children, 39 percent lived in poverty, account for only 38 percent of the overall five times the rate for white, non- population of the county. Hispanic children.

An estimated 192,502 children lived in Source: 2010 Decennial Census Summary File 1, 2011. American Community Survey 2010 1-Year Estimates, poverty in Dallas County, which amounts U.S. Census Bureau, 2011.

15 Zach Guillot

hen Zach Guillot was five, he was a typical kindergartner who loved playing with W Legos and dressing up in Star Wars or Indiana Jones costumes.

But one day, his mom, Julie, noticed that Zach had bruises on his legs. Shortly after that he was treated for a sore on his tongue, which went away. Zach also had a cough and stomach pain, and he complained of a headache that lasted for eight days.

On their third visit to their pediatrician, Julie requested a blood test. She had Googled the symptoms of leukemia 10 times and had begun to suspect her son had a serious illness, even before Zach was diagnosed with acute myelogenous leukemia (AML) on Feb. 3, 2010.

AML, a fast-growing cancer of the blood and bone marrow, usually is diagnosed in senior citizens. Despite the fact that fewer than 10 percent of AML patients are children, AML is the second most-common form of pediatric leukemia.

But AML can be successfully treated in children with chemotherapy, often followed by a bone-marrow transplant. The key is to find a donor whose marrow is a suitable match for the patient’s.

All of Zach’s family members were tested, and it turned out that his 3-year-old brother, Jake, was the perfect match for an allogeneic marrow transplant.

Zach first underwent three intense rounds of chemotherapy at Children’s, and in early June 2010 he underwent the bone-marrow transplant. He has done remarkably well since the transplant, and his hair has now grown back.

Twenty-five percent of all the new childhood cancer cases in Texas are treated at Children’s Medical Center, which has one of the largest pediatric hematology-oncology programs in the country. More than 600 children are newly diagnosed with cancer, sickle cell disease, hemophilia and other blood disorders at Children’s each year. Children’s is the only National Cancer Institute-designated pediatric cancer program in North Texas.

16 Children Without Health Insurance Percent of Dallas County’s children who are without healthcare insurance

2000 2005 2006 2007 2008 2009 2010

19.6 23.5 25.8 25.5 25.0 22.1 17.9

Data Source: The percentage of children without healthcare insurance: 2000, 2006 & 2007 Small Area Health Insurance Estimates; 2005 Texas State Demographer; 2009 & 2008 American Community Survey; 2010 Center for Public Policy Priorities.

According to the Institute of CHIP. These included easing the However, the new state budget for Medicine, children who are insured enrollment process for families, Fiscal Year 2011-12 cut inpatient chil- are more likely to have a medical implementing a 12-month eligibility dren’s hospital rates, as well as all home and to get their immuniza- period for Medicaid, implementing doctor and dentist reimbursement tions, preventive checkups, needed an aggressive marketing and out- rates, by 10 percent. According to medications and dental care. They reach campaign and increasing the the Texas Tribune, the budget also get earlier diagnosis and treat- reimbursement rates paid to health- decreases Medicaid outpatient rates ment of serious health problems, care providers. for children’s hospitals by 10 percent are hospitalized less often, and and reduces payments for non- Perhaps as a result, American have better-controlled asthma and urgent emergency room care. Community Survey estimates from improved attendance at school. 2008 through 2010 demonstrate a The Children’s Hospital Association An estimated 750,000 uninsured clear downward trend in the per- of Texas estimates that nearly 60 Texas children are eligible for, but centage of children who are percent of the patients treated at not enrolled in, Medicaid or CHIP. In uninsured in Dallas County, which is the seven nonprofit children hospi- 2004, steps were taken by the state consistent with the steady upward tals it represents are on Medicaid. to increase the number of Texas trend in the number of children on In some areas, that figure can reach children covered by Medicaid or CHIP and Medicaid. as much as 80 percent.

In a welcome downward trend, 17.9 percent of Dallas County children now are uninsured.

17 Children Enrolled in CHIP Number of Dallas County children in the Children’s Health Insurance Program in December each year

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

12,072 41,688 47,783 41,475 33,873 33,325 36,931 40,207 54,000 56,490 59,424

Data Source: The number of Dallas children enrolled in the Children’s Health Insurance Program in December: Children’s Health Insurance Program Monthly Report.

As a joint federal and state program, national projection to provide cover- medical home with timely access CHIP provides affordable healthcare age through Medicaid and CHIP for to specialty care when needed. coverage for working families who 4.1 million children by 2013 that The percentage of Texas physicians earn too much to qualify for Medicaid would otherwise have been unin- who report acceptance of new but can’t afford commercial health sured, CHIP enrollment has only Medicaid/CHIP patients dropped coverage. Eligibility requires that a grown marginally in relation to the from 67 to 42 percent in 2010. child be a U.S. citizen or legal perma- percentage of uninsured children in The Dallas CHIP Coalition is one nent resident, under age 19 and Dallas as a whole. of a number of community-based uninsured for at least 90 days. Family organizations that link with schools, Due to pervasively low rei-mburse income and resources must be above faith-based organizations, and ment rates for CHIP healthcare the Medicaid eligibility limit and at or service providers and business service providers, the network of below 200 percent of the federal to increase the access of families physicians who accept CHIP contin- poverty level (an annual income of to CHIP and Medicaid. The Center ues to shrink, making it less likely $44,700 for a family of four). for Public Policy Priorities estimates for enrolled children to have a that an estimated 1 million Texas CHIP Perinate, established in 2007, children may be eligible for Medicaid provides another component of or CHIP but are not enrolled. services to the unborn children Additionally, with a large percentage of pregnant woman, regardless of The percentage of of the nation’s undocumented citizenship status, with a family Texas physicians population residing in Texas, it income of up to 200 percent of the who report should be noted that undocu- federal poverty level. Coverage mented children are not eligible includes prenatal care, delivery and acceptance of new for CHIP or Medicaid. healthcare for the infant. In August Medicaid/CHIP 2011, CHIP Perinate enrollment in Budget cuts to Medicaid and CHIP Texas was 36,824, including 6,938 patients dropped programs will only serve to exacer- in Dallas County. from 67 to 42 bate the lack of, or inadequate access to, quality healthcare for Despite an easing of the enrollment percent in 2010. Texas children. process for participants, and the

18 Children Enrolled in Medicaid Number of children younger than 19 enrolled in Medicaid in December each year

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

75,330 87,996 139,750 166,143 179,551 180,943 176,852 185,641 184,357 217,560 257,315

300,000

250,000

200,000

150,000

100,000

50,000

Data Source: The Texas Health and Human Services Commission Strategic Decision Support: Point in time enrollment report.

For the nearly 200,000 Dallas County 2011 is an annual income of $22,350 who accept Medicaid patients contin- children living in poverty, Children’s for a family of four. Younger children ues to decrease sharply, and the Medicaid is a vital part of any hope are eligible at income levels of up primary reason physicians reported they may have of thriving and ulti- to 185 percent of the poverty level, for limiting their participation in mately improving their economic meaning a family of four would Medicaid is low reimbursement rates. positions in our society. While the qualify with an annual income of The cuts to state budgets will also number of Dallas County children $41,348. A significant number of have a significant impact on the pro- enrolled in Medicaid has increased families with low incomes either do gram and likely will adversely affect threefold over the past 10 years, not realize that their children are the ability of Dallas County’s poorest more than 1 million Texas children eligible for Medicaid or are unable residents to have dependable access may be eligible for Medicaid or to complete the application process, to healthcare. While Medicaid pro- CHIP but are not enrolled. which can be quite cumbersome. vides services for those most at risk To qualify, children must be legal Advocacy groups have worked to in our society, the Medicaid program citizens or legal permanent residents. increase awareness of eligibility, and also supports physician training, For school-aged children, their fam- hence increase the access to health- pediatric specialty procedures and ily’s earnings must be at or below care services for vulnerable children. high-technology care that benefit the federal poverty level, which in However, the number of physicians the community as a whole.

More than 1 million Texas children may be eligible for Medicaid or CHIP but are not enrolled.

19 Children Enrolled in Medicaid and Receiving Dental Care Number of eligible Dallas County children who receive dental care through Medicaid

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

43,174 49,586 66,301 101,494 125,799 132,743 135,539 149,773 166,205 196,703

Data Source: Texas Department of State Health Services, Medical and Dental Statewide Reports.; HHSC THSteps HISR303A.

Of the 316,739 enrolled in Medicaid dentists. Dentists often cite the children who are at highest risk for and CHIP in Dallas County in 2010, it low levels of reimbursemen t and dental problems still are least likely is estimated that since 2009 more the difficulties of dealing with the to receive preventive dental care. than one-third of that number did state program as two reasons for Supporting these findings, the Pew not receive full, regular dental care. not accepting Medicaid patients. Center on States identifies dental Reimbursement rates for dental In 2010, the National Institutes of care as the greatest unmet need for care are on a fee-for-services basis, Health reported that children who health services among children. at 50 to 60 percent of the usual have dental insurance through Eighty percent of dental disease is fees charged by practitioners. Medicaid and other public insurance concentrated in 25 percent of chil- programs are less likely to visit the A 2010 study done by the National dren, and those from poor families dentist regularly than privately Institutes of Health found that Latino face disproportionately high barriers insured kids. According to the study, and black children are more likely to getting care. The 2010 NIH report and as mirrored by the Medicaid pro- than white children to have never concluded that when states cover gram broadly, there is a shortage of seen a dentist, or to have had visits care with maximum income-eligibil- dentists who accept Medicaid. Unlike longer than six months apart, even ity at 200 percent of the federal general health, where providers such if covered by Medicaid. Though poverty level (instead of 185 per- as community clinics may supplement recent studies have found that the cent), there is a greater likelihood private practices, the dental care field proportion of U.S. children with a that near-poor children will receive is dominated by privately practicing preventive dental visit is now higher, preventive dental care.

More than 100,000 children in Dallas County do not receive full regular dental care, despite being on CHIP and Medicaid.

20 Children Enrolled in Medicaid and Receiving Texas Health Steps Medical Screening Services Number of eligible Dallas County children who receive medical screening services through Texas Health

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

36,472 33,395 41,362 124,727 140,724 149,128 154,116 165,885 146,368 154,644

175,000 150,000 125,000 100,000 75,000 50,000 25,000 0

Since 2000, Dallas County has seen home visits when other attempts to a four-fold increase in Texas Health reach families are unsuccessful. In 2010, Texas Steps enrollment. The program Under its broad mandate, the pro- Health Steps serves as a first line of intervention gram has taken many novel steps to for low-income families by providing launched be more user-friendly and increase preventive and primary medical and participation and Medicaid enroll- “Teen Page.” dental-care coverage to eligible chil- ment. In 2010, Texas Health Steps dren from birth through age 20. launched “Teen Page,” providing Through this extensive outreach and informational and interactive ing enrollment, due to the decreas- education program, the state encour- resources that encourage teens to ing number of providers who accept ages Medicaid-eligible families to get participate in fully managing their Medicaid, access to Medicaid-funded age-appropriate preventive care for personal health. healthcare continues to be a prob- their children. This encouragement Despite these promising steps at lem for many families who are comes in the form of calls to Medicaid increasing participation and expand- already enrolled. families, mail reminders to clients and

21 Early Prenatal Care Percent of women receiving prenatal care beginning in the first trimester of pregnancy

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

69.6 71.3 75.5 76.4 79.9 58.0 51.8 48.7 49.8 52.0 54.6

Data Source: Texas Department of State Health Services, Center for Health Statistics.

In 2010, more than 45 percent of the statistics. This change notwith- to enroll her unborn child. Services births in Dallas County were to moth- standing, since 2007 there has been include prenatal care, delivery and ers who had received inadequate a steady increase in the number health for the infant after birth. prenatal care. The Center for Disease of women receiving prenatal care Women who are not U.S. citizens can Control and Prevention estimates beginning in the first trimester. This receive emergency Medicaid to cover that nearly one-third of the women increase is likely due to the passage delivery, but do not receive prenatal represented in this report will have in 2008 of House Bill 2896, adopted or postpartum care. had some kind of pregnancy-related by the 76th Legislature of Texas, The policy enhancements that have complication. which directed the Texas Department likely contributed to the steady of Health and Human Services to The stark drop-off of women increase in the number of women devise new policies to promote receiving prenatal care in the first beginning prenatal care in the first early access to prenatal care. trimester of pregnancy in 2005 is trimester will now be tested by explained by the change in data Notable developments include the budget cuts that will inevitably have collection on state birth certificates creation of Medicaid Perinate, which significant impact on Medicaid’s abil- in 2005. Instances where the exact allows pregnant women with a family ity to meet the prenatal needs of commencement of prenatal care is income of no more than 200 percent low-income women. unknown are no longer included in of the federal poverty level ($44,700)

Low-income women may enroll their unborn children in the Medicaid Perinate program.

22 Infant Mortality Rate and number of infants under 1 year old who died per 1,000 live births in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Number 235 272 285 340 285 300 334 322 290 310 Rate 5.5 6.3 6.6 8.0 6.7 7.1 7.6 7.2 6.7 7.3

Data Source: Texas Department of State Health Services, Center for Health Statistics.

A report by the Texas Department rate has jumped around, but since non-Hispanic black women to an State Health Services states: “The 2006 it has declined consistently. infant mortality rate 2.4 times the infant mortality rate is a measure of The .6 percent increase in the rate rate for non-Hispanic white women. the overall health of a community.” of infant deaths in 2009 can be Non-Hispanic black, American Indian This report on Dallas County finds attributed to a wide variety of social, or Alaska Native, and Puerto Rican that in 2009, 310 children did not cultural, economic, and policy-ori- women have the highest infant mor- survive past their first birthdays. ented factors. High infant mortality tality rates; rates are lowest for Asian rates are often indications of poor or Pacific Islander, Central and South From a high of 8.0 (equivalent to 340 maternal health, inadequate prenatal American, and Cuban women. deaths) in 2003, the infant mortality care, infant malnutrition and/or limited Prematurity is the leading cause access to adequate health care. The of illness and death for newborns. leading causes of deaths for infants In 2009, 310 According to the CDC, 36.5 percent include premature birth, congenital of infant deaths in the U.S. in 2005 children in Dallas abnormalities, infections, and sudden were due to preterm-related causes. infant death syndrome (SIDS). County did not Maternal health, nutrition and first survive past their Race has been recognized as a sig- trimester onset of prenatal care have nificant predictor of infant mortality. all been identified as major contribu- first birthdays. The high prevalence of poor socio- tors to improved birth outcomes. economic conditions predispose

23 Brianna Lamar

rianna Lamar, who is 15 and a sophomore at Skyline High School, plays the flute. She B plays volleyball. She’s got her sights set on earning a scholarship to Texas A&M University. After she gets her undergraduate degree, she wants to become a veterinarian.

Brianna also is living with HIV. Both of Brianna’s parents had AIDS, and the now-common medications that prevent mother-to-child transmission of the disease were not yet available when Brianna was born.

HIV was considered an automatic death sentence for infants when Brianna was born. Doctors told her grandmother, Freddie Easley, that Brianna probably wouldn’t live to see her first birthday.

Brianna was sent to Children’s, where physicians were involved in a research trial to see if new medication cocktails that were showing positive results in adults would have similar effects in children. They enrolled Brianna in the trial.

“The doctors took us through the whole explanation of how it might not work and might be risky,” said Mrs. Easley. “But if you’re told your child will not live, you’re willing to try just about anything.”

The trial saved Brianna’s life, and the medication has allowed her to grow and develop into the healthy teenager she is today.

The staff in the ARMS (AIDS-Related Medical Services) program at Children’s have closely followed and supported Brianna her entire life. ARMS is the only program in North Texas devoted exclusively to caring for children with HIV and babies born to HIV- infected mothers.

Dr. Tess Barton, medical director of ARMS, has been Brianna’s doctor for the last several years. She expects Brianna to live at least into her 30s or 40s, and says that Brianna could live much longer than that if medical advances continue.

“I’m confident,” Dr. Barton said, “that Brianna will be alive long enough to be elected president.”

24 Premature Births Percent and number of babies born before 37 completed weeks of pregnancy

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 3,897 3,856 4,355 4,403 4,864 5,739 6,039 6,328 5,551 5,519 5,030 Percent 10.9 10.7 11.0 11.2 12.8 13.8 13.9 14.4 13.0 13.2 NA

Data Source: Texas Department of State Health Services, Center for Health Statistics.

Though the data must be treated as Americans (12.9 percent); Hispanic Dallas’ rate of premature births provisional, this report finds that in infants (11.4 percent); white infants since 2007 also has come down to 2010, about 25 infants per month in (10.7 percent); and Asian infants a new five-year low. Complimentary Dallas County did not survive their (10.2 percent). Mothers younger to the trends in neighboring North first year of life. The Center for than 20 or older than 35 have Texas counties and nationally, from Health Statistics reports prematurity higher rates of preterm delivery. 2007-2010 Dallas exhibited three con- as the leading cause of newborn secutive years of decline in preterm Similar to the up-and-down but death. If they survive, babies born births. The substantial decrease in decreasing pattern seen in the rate prematurely (before 37 completed 2010 would require a deeper, more of infant mortality in the county, weeks of pregnancy) are at risk detailed investigation to explain. for low birth weight, intellectual However, in addition to the touted disability, cerebral palsy, lung and Mothers younger effectiveness of aggressive prenatal gastrointestinal problems and vision care and maternal health initiatives, and hearing loss, as well as death. than 20 or older a 2011 published study of 465 women found evidence that the use Closely linked with the high rate of than 35 have of progesterone gel is associated infant mortality in non-Hispanic higher rates of with a 45 percent reduction in the black women, the highest prematu- preterm delivery. rate of preterm birth and improved rity rate (17 percent of live births) is neonatal outcomes generally. found in black infants; Native

25 Low-Birthweight Babies Percent and number of infants in Dallas County weighing 2,500 grams (5.5 pounds) or less at birth

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Number 3,929 3,931 3,936 3,980 4,162 4,254 4,453 4,568 4,251 3,524 Rate 9.2 9.1 9.1 9.4 9.7 10.0 10.1 10.2 9.8 8.3

NUMBER 5,000

4,500

4,000

3,500

3,000

Data Source: Texas Health and Human Services Commission.

The primary cause of low-birthweight their peers. Many very low-birth- despite relatively good birth out- babies (LBW) is prematurity, defined weight babies never catch up, and comes for immigrant Mexican as birth before 37 completed weeks consequently develop a development women, there may be significant of pregnancy. Very low birthweight curve parallel to that of an infant underreporting of birth outcomes, (VLBW) babies often are born before born at normal weight. since they are more likely than 30 completed weeks of pregnancy. women in other racial or ethnic Low birthweight is ranked as the groups to give birth outside of The most recent numbers show most prevalent cause of death a hospital. that in 2009, 3,524 low-birthweight among African-American infants. babies were born in Dallas County, Black infants are almost twice as Prenatal care, where the health of more than a 20 percent decrease likely to be born at low birthweight, mother and fetus is monitored, is since 2008. and they are four times as likely to a key factor in preventing preterm die as infants due to complications birth and very low-birthweight Low-birthweight babies and birth associated with LBW as non-white babies. Expectant mothers are defects are the leading cause of Hispanic infants. advised to eat a healthy diet and infant mortality in the U.S. Many gain the proper amount of weight LBW infants experience neurological The adverse health outcomes for during pregnancy. Additionally, preg- problems at birth, impairing their Latinos differ significantly by subpop- nant women are advised to avoid physical, emotional and intellectual ulation. Puerto Rican women have a alcohol, cigarettes and illicit drugs, development. For some LBW infants much higher incidence of LBW which can contribute to poor fetal it takes up to 3 years to catch up infants than Cuban women. Further, growth, among other complications.

In 2009, 3,524 low-birthweight babies were born in Dallas County.

26 Adolescent Pregnancy Number and rate of pregnancies per 1,000 females ages 13-17 in Dallas County. Figures include live births, fetal deaths and aborted pregnancies

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Number 2,935 2,758 2,741 2,760 2,732 2,611 2,741 2,815 2,729 2,531 Rate 37.7 35.1 34.2 34 33.4 31.6 32.4 33 32 29.6

Data Source: Texas Department of State Health Services, Vital Statistics Annual Reports: Table 14.

The most recent data shows that report by the Guttmacher Institute tions including death, anemia, physi- the number of births to Dallas teens found that in 2005, Texas had 88 cal assault, and sexually transmitted between the ages of 13-17 decreased pregnancies per 1,000 females 15-19, diseases (STDs) that may lead to by almost 10 percent, from 2,729 in compared with a national average of pelvic inflammatory disease, ectopic 2008 to 2,531 in 2009. 69.5. The article also found that in pregnancy, infertility, cervical cancer and death. STDs can be passed The decrease in births to teens ages 2006, Dallas County led the nation in to newborns before, during or just 13-17 notwithstanding, in 2010 The the percentage of repeat teen births. after pregnancy and can harm Dallas Morning News reported that In 2008, with 3,529 births, Texas babies by causing blindness, pre- Texas ranked third nationally in teen ranked as the third-highest state mature delivery, mental retardation, births and fourth-highest in teen with teens reported to have had a low birthweight and death. pregnancy in the country. A 2010 repeat birth. An estimated 10 percent of the According to Texans Care for Children, 176,223 deliveries paid for by although most teen pregnancies are Births to Dallas Medicaid in 2008 were to teens ages unintended, research has shown that teens decreased 13-17, at a cost of $41 million. Teen science-based, comprehensive sexual- pregnancies put both mother and ity education, access to contraception almost 10 percent child at risk. Statistics show that and youth development programs in 2009. teenage mothers are more likely to can help teenagers make choices that experience health-related complica- protect them from pregnancy.

27 Immunizations Percent of 2-year-olds vaccinated on the 4:3:1:3:3:1 schedule and at the appropriate age

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

63.8 59.6 63.2 61.9 64.2 71.5 70.1 68.5 68.6 70.5 64.7

Data Source: Centers for Disease Control and Prevention, National Immunization Survey, 2000-2010; Madison Park and Elizabeth Landau (CNN).

In 2010, more than one-third of had published Dr. Andrew Wakefield’s leaders are targeted to act as Dallas County children were not controversial research. Even with neighborhood-based advocates fully immunized, according to the this evidence, a CNN report found encouraging parents to fully immu- National Immunization Survey con- that few of the British parents who nize their children by age 2. When ducted by the Center for Disease withheld inoculations from their large numbers of children are not Control and Prevention. children were swayed by the revela- fully immunized, the chances of an tion that Dr. Wakefield’s findings epidemic increase substantially. Despite a 2004 Institute of Medicine were in fact fraudulent. of the National Academy finding to the contrary, some parents voice The National Vaccine Advisory concerns that the MMR (measles, Committee has identified several In 2010, more mumps and rubella) vaccine and barriers to timely vaccinations, thimerosal-containing vaccines are including a lack of insurance and than one-third of linked to the onset of autism. In parental lack of education, which Dallas County 2010, a study linking the vaccine to reduces the likelihood of parents children were not autism was discredited and subse- understanding the importance of quently retracted by The Lancet, the keeping vaccinations up to date. fully immunized. respected British medical journal that Faith, medical and community

28 Infants Breastfeeding at 6 Months Old Percent of 6-month-olds receiving any human milk

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

28.4 NA 30.0 NA 36.5 37.5 35.5 37.3 43.8 48.7 43.6

Despite a majority of newborns in 1999-2006 were significantly higher phone survey. But the numbers shift Dallas County being breastfed before among those with higher income (74 widely, based on region, according to leaving the hospital, in 2010 less percent) compared with those who a 2010 report. than 45 percent of babies are still had lower income (57 percent). The American Academy of Pediatrics being breastfed six months later. Breastfeeding rates among mothers recommends exclusive breastfeeding 30 years and older were significantly The CDC reports that racial and for the first six months of life and higher than those of younger mothers. ethnic disparities in breastfeeding continued breastfeeding until the rates are pronounced. Breastfeeding Nationwide, 54.4 percent of African- child’s first birthday. Breastfeeding is rates increased significantly among American mothers, 74.3 percent of strongly encouraged because breast non-Hispanic black women from 36 white mothers and 80.4 percent of milk contains many antibodies not percent in 1993-1994 to 65 percent Hispanic mothers attempted to found in commercial formulas that in 2005-2006. Breastfeeding rates in breastfeed, according to a CDC tele- help protect infants from disease.

In 2010, less than 45 percent of Dallas County babies were breastfed six months after birth.

29 Children With Developmental Disabilities Estimated number of Dallas County children with developmental disabilities

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

18,571 18,846 19,169 19,169 19,806 20,113 20,392 20,663 20,883 21,101 21,305

22,000

21,000

20,000

19,000

18,000

Data Source: The Arc of Texas.

The Arc of Texas estimates that 3 and coordinated services from schools Buy-In for Children program author- percent of children in the US have and social service programs. A 2008 ized by the Texas Legislature also developmental disabilities — physi- report by the U.S. Department of provides assistance by paying med- cal or mental impairments that begin Justice depicted the failure of state ical bills for children with disabilities. before age 22 and significantly affect schools to meet the health and safety Parents with income up to 300 per- a child’s daily function. Autism needs of their residents, especially cent of the federal poverty level spectrum disorders, cerebral palsy, children and the medically fragile. ($67,050) are eligible. This program degenerative disorders and disorders helps families who need health There was some responsiveness in affecting the nervous system, are insurance but earn too much to 2009 from the 81st Legislature by but some of the major causes of qualify. Families may “buy in” to increasing funding and expanding developmental disabilities. The chil- Medicaid by making a monthly services to Texans living with develop- dren require individually planned payment (premium). mental disabilities. The Medicaid

In 2010, there were 21,305 children in Dallas County with developmental disabilities.

30 Children Receiving Services for Special Healthcare Needs Number of children in Dallas County receiving special healthcare services

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Receiving Service 456 287** 337 NA NA 395 417 465 484 425 465 Wait Listed NA NA 201** NA 113 217 236 276 128 109 171

Data Source: Texas Department of State Health Services.

The Children with Special Health Care ices or remains on the waiting list. and that parents are satisfied with Needs (CSHCN) Services Program has Often, this requirement has the effect their child’s care. Data is currently been helping children in Texas with of reducing the number of children available on the CDC website for special needs for almost 90 years. on the waiting list. the years spanning 2001-07. Established in 1933, the program Texas residents younger than 21 (or In Texas, a review of the rules that helps the families of children with a of any age with cystic fibrosis) with govern the state CSHCN program chronic physical or developmental a chronic medical problem limiting is scheduled for late 2011, and condition manage the extreme finan- one or more major life activities and the Chronic Illness and Disability cial and other challenges they face needing more healthcare than chil- Transition Conference, to be hosted when caring for these very fragile children usually require, are eligible. by the Baylor College of Medicine dren with the most severe disabilities. Income requirements are also factored in fall 2011, should also provide a In 2010, 465 Dallas County children into eligibility. The program does not much-needed platform for all stake- and their families benefited from the cover clients with only a mental, holders to voice concerns and services provided by this program. behavioral or emotional condition, advocate for access to resources Another 171 were wait-listed. These or a delay in development. and support for CSHCN families. numbers represent an almost 10 An annual telephone survey by the percent increase in the number of Centers for Disease Control and clients served from 2009. Prevention was conducted in 2009- In 2010, 465 Dallas Due to limited state funding, eligible 10 in most U.S. states, and the children may be placed on a waiting Virgin Islands. The survey explores County children list and would not receive vital serv- the extent to which children with and their families ices until a space opens up. Each special health care needs have benefited from applicant’s family must reapply every medical homes, adequate health six months, regardless of whether a insurance, access to needed serv- CSHCN services. child is already receiving CSHCN services, adequate care coordination,

31 Overweight or Obese Children Percent of Dallas County high-schoolers estimated to be overweight or obese

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

NA 33.7 NA 35.8 NA 38.4 NA 38.3 NA 36.1 NA

Data Source: Youth Risk Behavior Survey 2000-2010, Centers for Disease Control and Prevention.

At 36.1 percent in 2009, Dallas Children’s Medical Center provides sively address this growing social County is significantly higher than the services annually to more than and economic problem, by limiting Texas estimates for high school stu- 7,500 patients with obesity-related the availability in schools of so- dents who are overweight or obese. diagnoses. In a 2006 Policy Health called “competitive foods,” which Both state and county statistics are Forum, held in Austin, it was reported are typically more calorie-dense and almost double the national averages that a child who is overweight at nutrient-poor than are traditional according to the Department of State 12 has a 75 percent chance of being meals. Health Services. Literally, one in every overweight as an adult, and it Further legislation requires schools to three Texas high-schoolers is over- asserts that Texas is facing an increase physical activity from moder- weight or obese. unprecedented health care crisis ate to vigorous levels for elementary if nothing is done. A national trend, mirrored on the to middle school students. For these county level, finds that the incidence Projected costs for obesity-attribut- students a minimum of 30 minutes of overweight and obesity occurs at able state expenditure were estimated of physical activity is required, and a much higher rate for African- at $15.6 billion in 2010, and are recess has been removed as an Americans and Latinos than for estimated to reach $39 billion by acceptable standard. whites. Generally, poor diets due low 2040. Texas continues to aggres- Notably, on the national level, First socio-economic status appear to be Lady Michelle Obama has made the main driver of these findings and childhood obesity the focus of her other negative health outcomes. One third of “Let’s Move!” health initiative, which Being overweight or obese is linked Dallas County includes encouraging children to with many common and costly exercise, providing more free and health problems, including Type 2 high-schoolers are reduced-price school meals, making diabetes (formerly adult-onset dia- estimated to be food in schools more nutritious and betes), stroke, heart disease, some generally engaging children more in forms of cancer, high blood pres- overweight or discussions about diet, exercise and sure, asthma, sleep apnea, severe obese. healthy living. heartburn, and gallbladder disease.

32 Teen Suicide Number of intentional deaths by suicide and other self- inflicted injury by Dallas County residents ages 10 to 19

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

13 12 14 16.0 12 14 8 16 16 14 6

Data Source: The Texas Department of State Health Service, Centers for Disease Control and Prevention.

In 2010, six Dallas County youths The National Youth Violence more likely to report serious thoughts took their own lives. Despite the fact Prevention Center identifies suicide of suicide. These troubling statistics that this number was down by more as the third leading cause of death notwithstanding, trends also show than half from 2009, it is still trou- among adolescents. An additional that almost three in every four bling that with available services, cause for concern is that suicide has ED visits for drug-related suicide and the multitude of new ways for been identified as the fourth leading attempts among adolescents were individuals to stay connected in a cause of death among children made by females. society where social media domi- between the ages of 10 and 14. Studies since 2008 have indicated nates, that any number of teenagers According to the 2010 DAWN Report, that pharmaceuticals were involved in would choose death over life. nationally, between 2005 and 2009, 95.4 percent of drug-related suicide Common risk factors contributing to there was a 36.7 percent increase in attempts among adolescents. Though the decision to take one’s own life the number of emergency department females are more likely to attempt include mental illness (especially (ED) visits for males aged 12-20, due suicide, males are four times more depression), a recent loss, drugs and to drug-related suicide attempts. likely actually to die from suicide. alcohol abuse, school or personal Additionally during the same period, The National Institute of Mental failure, and disruptive or aggressive the number of males aged 12-20 Health reports that more than 60 behavior. Experts also include the using anticonvulsants to commit sui- percent of all suicides involve hand- divorce of parents, violence in the cide saw a 265.5 percent increase. guns, with 80 percent of those being home, feelings of worthlessness, and Experts point out that the strongest committed by white males. As indi- rejection by peers as other contribu- predictor for a completed suicide is a cated, females are more likely to tors to teen suicide. previous attempt. Individuals with overdose, but their use of handguns substance dependence or abuse are has increased.

Six young Dallas County residents committed suicide in 2010.

33 Asthma Estimated number of children who have had asthma during their lifetimes

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

29,232 NA 53,346 55,708 55,484 58,455 62,248 60,680 64,127 56,403

Data Source: American Lung Association State of the Air Reports 2002, 2004-2010.

The Dallas/Fort Worth area has Legislature to fund emission reduc- a bipartisan group of senators to earned the dubious distinction of tion projects in eligible counties request that EPA keep the current moving up a spot to No. 12 on the throughout Texas. To develop a bet- standards in place until 2013. On American Lung Association’s “State ter scientific basis for responding to September 2, 2011, President Obama of the Air Report” rankings this year. this standard, the AQRP sponsored issued a statement that he had asked The region has received repeated an air-quality measurements program the EPA to withdraw the toughened grades of “F” for its number of in the Dallas/Fort Worth area. The ozone standards until the 2013 high-ozone days. public health benefits of attaining requested date. National Ambient Air Quality The number of Dallas County children With economic and political interests Standard can be substantial, but the estimated to be at risk from pediatric weighing in heavily on this issue, it costs of attaining the standards can asthma rose by 9.4 percent in 2010, is important not to ignore the reality also be high. EPA has estimated that from 60,680 to 64,127. However, that asthma is the most common compliance with a standard of 0.060 numbers appeared to be falling in chronic disease in children and could cost up to $90 billion per year 2011. The Asthma Coalition of Texas accounts for 14 million missed school by 2020. estimates that more than 10 percent days per year, according to the Journal of Texas children have had asthma The EPA Advisory Committee received of School Health. Primary care-based over their lifetime. more than 5,000 unique comments treatment has shown to prevent hos- on the proposed standards issued on pitalization; however, such treatment The Texas Air Quality Research January 6, 2010. In addition, more is unavailable to many children who Program (AQRP), funded by the than 200 stakeholders testified at the lack health insurance. Texas Commission on Environmental public hearings held in Virginia, Texas Quality was directed by the 81st and California. The projected costs led

The estimated number of Dallas County children at risk from asthma rose by 9.4 percent to 64,127 in 2010.

34 Asthma Hospitalizations Children who were hospitalized with a primary or secondary diagnosis of asthma or related respiratory conditions at Children’s Medical Center

2000 2002 2004 2005 2006 2007 2008 2009 2010

1,841 1,398 1,486 1,547 1,540 1,391 1,340 1,860 1,470

2,000

1,750

1,500

1,250

1,000

Data Source: Children’s Medical Center admission records.

In 2010, 1,470 Dallas County children people — seven million of them were admitted to Children’s Medical children — with asthma. Asthma and related Center with asthma or related The North Texas Asthma Consortium respiratory condi- respiratory conditions. Additionally, has developed an Asthma Toolbox asthma and related respiratory tions led to 1,470 that provides free educational tools conditions led to 5,904 Emergency for primary-care providers and school hospitalizations and Department visits. nurses, in addition to educating the 5,904 Emergency The notable drop in hospitalizations local community about the serious Department visits at between 2009 and 2010 may in part nature of asthma. Making the correct be due to numerous campaigns, diagnosis of asthma is extremely Children’s in 2010. locally through various health organ- important. In symptomatic children, izations and nationally through the asthma, which now is understood to National Asthma Control Initiative be a chronic inflammatory disorder, established by NHLBI, are the miti- (NACI), to increase awareness about causes recurrent episodes of wheez- gation of asthma triggers and use the disease. Inexpensive primary ing, breathlessness, chest tightness, of appropriate medications, as care-based treatment standards for and cough, particularly at night and in well as appropriate education asthma have been established by the early morning. Early clinical diag- for children and their families. the National Heart, Lung and Blood nosis is paramount, because signs Children’s Medical Center offers Institute (NHLBI). These standards and symptoms vary widely from an Asthma Management Program, help to reduce the incidence of patient to patient as well as within which delivers a six-month, bilingual asthma attacks, preserve lung func- each patient over time. outpatient educational program tion and facilitate a near-normal The key components of primary for parents on how to successfully lifestyle for the estimated 23 million care-bas ed standards for asthma, as manage their child’s asthma.

35 Juvenile Diabetes Children who were hospitalized with a primary or secondary diagnosis of Type I, Type II or steroid-induced diabetes at Children’s Medical Center

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

314 335 320 320 396 413 431 445 436 452 471

Data Source: Children’s Medical Center, 2010 Texas Chronic Disease Burden Report.

In 2010, there were almost 600 hospi- ary diagnosis of juvenile diabetes has of diabetes-related deaths in African- talizations of Dallas County children risen by 34 percent. This increase Americans and Hispanics remains under the age of 19 at Children’s alone would be of concern; however, significantly higher compared to Medical Center, with a primary or sec- the Texas Chronic Disease Burden whites and other racial/ethnic ondary diagnosis of juvenile diabetes. report (2010) ranked diabetes as groups. The report also indicated the sixth leading cause of death that the estimated average hospital These hospitalizations represent the in the state in 2006. Diabetes was per day cost for hospitalizations with ongoing battle of 471 Dallas County the fifth leading cause of death in a Type I/II diagnosis was $5,703. children. Juvenile diabetes is a meta- both the African-American and bolic disorder where due to a lack of Treatment of juvenile diabetes Hispanic communities in 2006. The insulin in the body, the cells of the starts first in the identification of number of children with Type II dia- body are unable to digest glucose or the disease process, its signs and betes also is increasing with the rise carbohydrates for energy. Additionally, symptoms, as well as its cause. of sedentary lifestyles and obesity. the inability of the body to facilitate There is no cure for diabetes. Eating glucose storage as glucagon rapidly On a positive note, the overall Age- the right kind of food, exercise and increases the amount of glucose circu- Adjusted-Mortality-Rate (AAMR) for other forms of physical activity, and lating in the blood, leading to several diabetes decreased significantly from having a healthy lifestyle generally health problems. 31.7 per 100,000 in 2001 to 26.6 per are key points in the treatment of 100,000 in 2006. However, the rate juvenile diabetes. Since 2000, the number of CMC admissions with a primary or second-

Since 2000, the number of Children’s admissions with a primary or secondary diagnosis of juvenile diabetes has risen by 34 percent.

36 Sexually Transmitted Diseases and HIV/AIDS Number of new cases in people under the age of 20

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Total 6,770 6,352 5,737 5,340 4,632 5,375 4,805 6,534 6,814 6,981 7,371

HIV/AIDS 32 34 29 33 28 36 50 45 51 59 NA

Syphilis 4,147 4,135 3,831 3,710 3,249 3,595 3,137 4,393 4,859 5,172 5,455

Chlamydia 2,558 2,124 1,809 1,541 1,304 1,653 1,480 1,976 1,769 1,549 1,754

Gonorrhea 33 59 68 56 51 91 138 120 135 201 162

Data Source: Texas Department of State Health Services, HIV/STD Reporting Database.

In 2010, a total of 7,371 Dallas The 2009 Youth Behavior Survey pose significant health risks, including County residents younger than 20 reports that in Texas, 51 percent of an increased likelihood of PID, prema- were diagnosed with a sexually trans- high school students reported that ture birth, miscarriage, stillbirth or mitted disease (STD) or infection. they had sexual intercourse; 57.7 severe complications in newborns. percent reported that they used a con- Some STDs can be treated success- With the exception of gonorrhea, dom in their last sexual encounter; fully with antibiotics, but many go which has declined somewhat, the and 21.7 percent reported that they undiagnosed and can result in severe numbers for each disease all repre- had used drugs and/or alcohol before damage to the nervous system, heart sent an increase. In syphilis their last sexual encounter. and brain. diagnoses for this age group there was an increase of 9 percent, and These statistics should be a cause The Centers for Disease Control and there was an increase of more than 8 of concern because contracting Prevention recommend that girls percent in chlamydia. In 2009, HIV chlamydia can result in serious com- receive the human papillomavirus diagnoses were on a consecutive plications such as pelvic inflammatory (HPV) vaccine prior to becoming three-year increase, with 59 reported. disease (PID) and ectopic pregnancy. sexually active. The HPV vaccine has Adolescent females are more suscepti- been found to protect against 70 According to a 2011 report from the ble than adults to infection, and STDs percent of cervical cancers. An addi- Kaiser Family Foundation, women of tional treatment tool now used by color, particularly black women, are Texas physicians to break the cycle disproportionately affected by of chlamydia and gonorrhea that HIV/AIDS. Black women accounted In 2009, 51 percent plagues hundreds of thousands of for 64 percent of estimated AIDS of Texas high residents each year is expedited part- diagnoses among women ages 13 ner therapy. Explicitly permitted by and older in 2009, but are only 12 school students an amendment to the Texas Medical percent of the U.S. population of reported that Board (TMB) rules, physicians may women. Latinas accounted for 18 they had sexual now provide a prescription for an percent of estimated AIDS diagnoses, infected patient’s partner with whom but are 14 percent of the female intercourse. the physician doesn’t have a “proper population ages 13 and over. professional relationship.”

37 Emotional Disturbance or Addictive Disorder Estimated number of children with severe emotional disturbance and addictive disorders

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

123,806 125,639 127,794 127,794 132,039 134,088 135,949 137,750 139,221 140,672 142,036

150,000

14 0,000

130,000

120,000

Data Source: U.S. Department of Health and Human Services, Texas State Demographers.

Experts estimate that 20 percent estimates, approximately 142,036 Nearly 18 percent of Dallas County of all children have a diagnosable Dallas County children have a diag- children have no healthcare cover- emotional disturbance or addictive nosable emotional disturbance or age. Families may be unaware of disorder that results in at least min- addictive disorder. publicly funded options and unable imal impairment. A subpopulation to pay for services and medications Of this number, 35,509 young people of this group, estimated at about 5 out of pocket. In addition, insurance with an emotional disturbance may percent, includes children with a policies often provide only minimal go without treatment for several diagnosable disorder that results in coverage for mental health and reasons, according to Mental Health significant impairment. By these substance abuse treatment. America of Greater Dallas. The National Association of The National Federation of Families Children’s Hospitals and Related reminds us that all mental illnesses About 142,036 Institutions identifies a broad array and behavioral disorders are treatable. of necessary services for the popula- Dallas County In general, the earlier the diagnosis tion, ranging from early intervention and treatment, the less severe the children have to hospitalization. Ideally, services disease or disorder becomes. Parents should be family-focused, delivered a diagnosable may be embarrassed or feel the through community-based, easily emotional stigma that is often associated with accessible systems and offer a con- mental illness, symptoms are some- disturbance or tinuum of care in order to prevent times misidentified, and language or the development of more serious addictive disorder. cultural barriers make accessing treat- disorders and the need for more ment more difficult. expensive treatment.

38 Children Receiving Publicly Funded Mental Health Services Number of Dallas County children receiving publicly funded mental-health services through NorthSTAR

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

6,450 6,047 6,505 8,147 10,285 10,715 11,015 11,554 13,066 15,449 17,670

Data Source: NorthStar,Texas State Demographers, HHS. Numbers exclude alcohol-related disorders, drug-related disorders and mental retardation.

The number of Dallas County to families with an income at or service providers in Dallas, the children receiving publicly funded below 200 percent of the federal Texas Conservative Coalition mental health services has tripled poverty level ($44,700 for a family Research Institute (TCCRI) made from 2000 to 2010. Even with this of four in 2011). Both public and the recommendation that STAR growth, according to data on the private insurance plans fail to fully and STAR+Plus be expanded into estimated number of children with meet the level of need, neither do the Dallas service areas. developmental disabilities, an they necessarily guarantee mental According to HHS, as of February additional 25 percent of these healthcare, as most plans don’t 2011, children under the age of children are not receiving the provide equal coverage for mental 21 may voluntarily participate in services they require. health and medical care. the STA R+Plus Medicaid managed- NorthSTAR serves low-income children The ICM Medicaid delivery model, care program in Dallas County. and adults who have severe emo- created by House Bill 1771 in the Whether the availability of a new tional disturbance or substance-abuse 79th Legislature and rolled out in managed-care model will increase issues. The Children’s Hospitalization the Dallas and Tarrant service areas the number of children receiving Association of Texas’ 2006 “State of (comprising 12 North Texas counties) services remains to be seen, in light the State Report” states that mental- in 2007 and 2008, was criticized of impending budget cuts likely to health services available to these and deemed to be flawed by HHSC. disproportionately impact Medicaid children are limited, and those that In response to difficulties between and other programs that serve low- are available are disproportionately the managed care programs that income children. crisis services. Services are available operate CHIP and the NorthSTAR

Both public and private insurance plans fail to fully meet the level of need for mental health.care

39 Annabella Spears

lexa Spears looks at her 1-year-old and can’t believe all she has been through. Baby A Annabella’s physical appearance doesn’t reveal that she spent most of her first year waiting on a life-saving organ. Developmentally, she’s right on track.

Only the scar across her belly serves as a daily reminder of the past year’s events.

First-time parents Alexa and Shad brought newborn Annabella to their Dallas home, but after seven weeks, they noticed that her skin looked yellow. A trip to the pediatrician landed Annabella at Children’s Medical Center, where she underwent extensive testing and was diagnosed with biliary atresia, a rare disease of the liver and bile ducts.

Without a transplant, Annabella’s liver would fail. She was listed for a new liver in March 2011.

“I didn’t want to ask, but I kept wondering if we would lose her, because I had no idea really what ‘transplant’ meant, and it sounded really scary,” Alexa said. “I just kept thinking that we couldn’t lose our little girl.”

All her parents could do was to wait for a liver that would be a match for Annabella. She regularly visited the Solid Organ Transplant clinic at Children’s and was closely monitored.

Dr. Dev Desai, division director of pediatric trans- plantation at Children’s and associate professor of surgery at UT Southwestern Medical Center, would be the surgeon implanting the liver when the time came. “Annabella’s liver failed rapidly, and because of the quickness of her disease, she went to the top of the waiting list,” Dr. Desai said.

At 6:30 a.m. on June 16, Alexa and Shad received the call they had been waiting on for three months. They couldn’t believe the day had finally come.

Dr. Desai flew in a jet to procure the organ, return- ing to Children’s where 8-month-old Annabella was in the operating room being prepped. After a successful surgery, Annabella recovered perfectly.

“It’s pretty amazing — her skin has gotten pinker, and the whites of her eyes are white again, instead of yellow,” Alexa said. “She has energy plus, and she is rolling over, lying on her belly and having a great time. It’s remarkable.”

40 Food-Based Allergies Estimated number of Dallas County children with food allergies

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

49,522 50,256 51,118 51,118 52,816 53,635 54,380 55,100 55,688 56,269 56,814

Data Sources: The Centers for Disease Control and Prevention; Food Allergy Initiative.

According to the Centers for Disease Allergic reactions to foods can range Control and Prevention, a food allergy from a tingling sensation around the In 2010, 56,814 is a potentially serious immune mouth and lips to hives to death, Dallas County response to eating specific foods or depending on the severity of the food additives. Eight types of food allergy. Food allergy is more prevalent children were account for more than 90 percent of in children than adults, and a major- estimated to allergic reactions in affected individu- ity of affected children will "outgrow” have a food or als: milk, eggs, peanuts, tree nuts, food allergies with age. However, a fish, shellfish, soy, and wheat. In 2007 study has shown that milk digestive allergy. 2010, 56,814 Dallas County children allergy may persist longer in life than were estimated to have some sort previously thought. Of 800 children of food or digestive allergy. with milk allergy, only 19 percent had outgrown their allergy by age 4; 79 However, in the July 2011 issue of Nationally, from 2004 to 2006, there percent had outgrown it by age 16. Pediatrics, a Food Allergy Initiative were approximately 9,500 hospital study found that, according to its During the 10-year period before discharges per year with a diagnosis national survey of 38,480 families, 2006, food allergy rates increased related to food allergy among chil- 8 percent of children in the United significantly among both preschool- dren under age 18. The CDC also States – 1 in 13 — suffer from a food aged and older children. Children reports that food allergies result in allergy. This is nearly twice as many under age 5 had higher rates of over 300,000 ambulatory-care visits as previously believed. reported food allergy compared with a year among children. children 5 to 17 years of age. Boys In September 2010, Children’s Online resources for parents of and girls had similar rates of food Medical Center opened the only aca- children with food allergies include allergy. Hispanic children had lower demic-affiliated pediatric food allergy faiusa.org, kidswithfoodallergies.org rates of reported food allergy than center in North Texas. In 2011, the and AllergicChild.com. These websites non-Hispanic white or non-Hispanic 82nd Legislature passed Senate Bill and others provide information, black children. 27, introduced by Sen. Judith Zaffirini, allergy guides, recipes, and general to help protect students from poten- support for families. tial food allergies at school.

41 Methicillin-Resistant Staphylococcus Aureus (MRSA) Emergence of resistant staph infections as a serious health concern, especially for young athletes

Data Source: Children’s Medical Center, 2010 Texas Chronic Disease Burden Report.

Methicillin-resistant Staphylococcus 80th Legislature adopted HB 1082, school athletes, was first done in 2003 aureus (MRSA) is a bacterium which established a pilot program and was repeated in 2008. The report responsible for several difficult-to- for reporting methicillin-resistant focused specifically on athletes in the treat infections in humans. It may Staphylococcus aureus (MRSA) infec- University Interscholastic League (UIL) also be called multidrug-resistant tions. Amarillo Bi-City-County Health 4A/5A Regions I-IV. Region II includes Staphylococcus aureus or oxacillin- District, Brazos County Health Dallas County and surrounding areas. resistant Staphylococcus aureus Department and the San Antonio Mirroring the findings of the 2005 (ORSA). MRSA is, by definition, any Metropolitan Health District were the A&M study, Region II exhibited signifi- strain of Staphylococcus aureus that three counties selected to participate cantly higher prevalence of MRSA has developed resistance to beta- in the pilot program. infections, by sport, than other lactam antibiotics which include the In 2005, the Texas A&M Department regions, particularly in football and penicillins (methicillin, dicloxacillin, of Epidemiology and Biostatistics wrestling. Region II also exhibited a nafcillin, oxacillin, etc.) and the conducted a study on staphylococ- significantly higher number of MRSA cephalosporins (another sub-group cus-associated mortality in Texas. infections, by individual cases, again, of B-Lactam antibiotics). MRSA is Using Geographical Information particularly in football and wrestling. especially troublesome in hospitals Systems (GIS) research tools, the and nursing homes, where patients The most effective means of control- study identified high concentrations with open wounds, invasive devices ling the spread of MRSA include of MRSA deaths in metropolitan and weakened immune systems are keeping infected areas covered; wash- areas, including Dallas-Fort Worth. at greater risk of infection than the ing hands often; avoiding contact with general public. A Texas Department of State Health persons with MRSA infections; wash- Services and University of Texas at ing clothes and linens contaminated Few studies have estimated the Austin collaborative study on the with MRSA; and avoiding sharing occurrence of MRSA infections in a prevalence of MRSA infections in high personal items, such as towels. specific city or county. In 2007, the

A study identified high concentrations of MRSA deaths in metropolitan areas, including Dallas-Fort Worth.

42 Students Disciplined for Possessing Alcohol, Tobacco or Controlled Substances on School Grounds Number of public-school students disciplined for possession of illicit substances

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

1,134 1,929 1,946 2,247 2,473 2,289 2,338 2,753 2,722 2,964 3,182

Data Source: The number of children disciplined for possession of alcohol, tobacco or controlled substances at school. Texas Education Agency, PEIMS Reports: 2000-2011& http://www.dshs.state.tx.us/Substance-Abuse/

Disciplinary data from the Texas percent reported using some type of Disciplinary Alternative Education Education Agency depicts that sub- substance in their lifetime. The five Program (DAEP) referral rates for all stance abuse among young people substances most widely used by Texas school districts. The mission of remains a concern. In Dallas County, young people in Texas were alcohol, the organization is to ensure a fair controlled-substance abuse among tobacco, marijuana, inhalants, and solution to problems by focusing on students has increased in the years powder cocaine. the intersection of school discipline from 2000-2011. and gateways to the juvenile justice Alcohol was reported as the most system – sometimes called “the During the 2009-10 academic year, widely used substance among sec- school-to-prison pipeline.” 3,182 public school students in ondary-school students, with 63 Dallas County were disciplined for percent in 2008 reporting they had The Texas Appleseed report’s aim is possessing alcohol, tobacco or con- used alcohol at some point in their to inform the community of existing trolled substances on school lives. Beer was the most popular issues, as well as to provide recom- grounds. The majority of the offenses alcoholic beverage among past- mendations for educators and (73 percent) involved possession of month drinkers, followed by liquor. promote greater parental involve- controlled substances or drugs at ment within families, a goal that can Marijuana remained the most com- school. Fifteen percent involved pos- reduce the number of disciplinary monly used illegal drug among Texas session of tobacco, and 7 percent referrals for students at school. middle- and high-schoolers. About 25 involved possession of alcohol. percent of the students surveyed in The 2008 Texas School Survey of 2008 reported having smoked mari- Substance Use, conducted by the juana at some point in their lives. During the 2009-10 Texas Department of State Health Nearly 7 percent of Texas teens academic year, Services, surveyed 98,898 students reported having used powder 3,182 students in in grades 7 to 12 from 62 school dis- cocaine or crack, and 2.2 percent tricts on their self-reported use of reported past-month use. Dallas County were alcohol, drugs and tobacco. Forty-five Texas Appleseed has published vari- disciplined for percent of Texas secondary-school ous reports examining the disciplinary students in 2008 reported using possessing illicit data self-reported by school districts alcohol, tobacco, inhalants, steroids substances to the Texas Education Agency, calcu- or illicit drugs during the past school lating in-school suspension (ISS), at school. year, including the past month; 65 out-of-school suspension (OSS) and

43 Alcohol Related Deaths Number of child deaths related to alcohol use in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

20202101032

Data Source: The number of children disciplined for possession of alcohol, tobacco or controlled substances at school. Texas Education Agency, PEIMS Reports: 2000-2011 and http://www.dshs.state.tx.us/Substance-Abuse/

The number of child deaths attrib- According to the National Center on The North Central Texas Council of uted to alcohol use has remained Addiction and Substance Abuse, alco- Governments suggests that the consistent over the past decade. A hol is the most popular mind altering implementation of evidence-based total of 13 Dallas County residents substance among secondary-school prevention programs can make a under age 20 have died due to students. Moreover, a Dallas Public favorable impact on alcohol use either the direct or indirect use School survey from 2003 indicates among children, provided that it is of alcohol. an increase in alcohol use among disseminated broadly and equitably student in grades 6 through 12. among all schools.

Over the past decade, 13 Dallas County residents under age 20 have died due to either the direct or indirect use of alcohol.

44 Families With All Parents Working Number and percent of families in Dallas with all parents in workforce

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Number 383,961 359,048 409,395 411,490 184,638 179,517 193,173 182,302 196,103 189,697 Percent 68.0 60.0 67.7 66.7 64.4 63.9 65.7 62.4 66.6 65.7

Data Source: American Community Survey.

In 2009, almost two-thirds of Dallas occurs in preschool are essential faith groups, and community-based County children lived in households for healthy child development and programs for parents and children with either both parents working, or children’s school readiness. The are essential to meeting these the only parent in the household average cost for the care of a pre- many demands. working. school-aged child in Texas in 2010 was $6,454 annually — 10 percent Although the employment of a par- more than the average public col- ent or parents is a good indicator Almost 66 percent lege and university tuition fee. for the economic stability of the of Dallas County household, it also points to a crucial Working parents must balance high need for dependable childcare. demands on their time and energy children need Affordable and dependable childcare between family obligations and childcare because is important for children at any age. those in the workplace. Often the their parents work. support of a well-established social Childcare and the socialization that network, including family, friends,

45 Children Living in Poverty Percent of Dallas County children living in poverty (defined as an annual income below $22,350 for a family of two adults and two children)

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 112,505 122,938 131,929 153,274 154,985 152,672 158,381 167,374 171,467 184,940 192,502 Percent 17.8 19.2 20.2 23.5 23.6 23.6 24.0 25.5 25.5 27.2 29.4

Data Source: Small Area Income & Poverty Estimates, U.S. Census Bureau: 2009; Center for Public Policy Priorities; Texas Kids Count; American Community Survey.

Child poverty is on the rise in Dallas chronic health issues. Impoverished nation. As a result of the economic County, with rates that exceed the children run higher risks of dropping downturn since then and the conse- state and national averages. Since out of school, leading to inferior quential loss of jobs, the child 2000, the percentage of children liv- employment outcomes (National poverty rate increased to 29.4 ing in poverty in Dallas County has Center for Children in Poverty, 2009). percent in 2010. increased from 18.4 percent to 29.4, The U.S. government developed the As a result, 163,000 more children with 192,502 now living in poverty federal poverty thresholds and guide- were living in poverty, or 1.6 million (American Community Survey). lines to evaluate the needs of Texas children overall. According to According to the federal poverty individuals and families and designed the 2011 KIDS COUNT Data Book, guidelines of 2011, the federal various income criteria for programs compiled by the Annie E. Casey poverty level is defined as an annual such as the Supplemental Nutrition Foundation, 42 percent of our income below $22,350 for a family Assistance Program (SNAP, formerly nation’s children, or about 31 mil- of two adults and two children known as food stamps) and Medicaid. lion, lived in low-income families in (U.S. Census Bureau). 2009 — an increase of more than 2 As a result of the recession that million children since 2007. The 2011 Center for Public Policy started in 2008 and the rising levels Priorities’ report on the State of of unemployment, a higher number Texas Children denotes poverty as of children have fallen under the More than 29 the most reliable measure of child poverty line. The increased level of well-being, because of its effects on poverty implies a greater need for percent of Dallas multiple developmental outcomes. assistance, which in turn places limi- County children Children who grow up in poverty face tations on existing services. a higher risk of cognitive, emotional, now live in poverty, According to the Census Bureau’s educational, and health problems. exceeding state and Small Area Income and Poverty Those who encounter longer periods Estimates, Texas’ poverty rate for national averages. of poverty are subject to more severe 2008 was the fifth-worst in the consequences which often lead to

46 Children Living In Single-Parent Families Number and percent of children living in single-parent families

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 92,126 103,302 94,756 93,371 103,877 95,317 102,425 98,639 101,337 103,130 100,067 Percent 29.1 37.8 32.7 33.4 36.2 33.9 34.8 33.8 34.4 35.7 35.1

NUMBER 105,000

100,000

95,000

90,000

Data Source: American Community Survey.

More than one-third of Dallas County poverty, due to the generally lower they increase the likelihood that the children live in single-parent homes. earning potential of women. Other child will drop out of school, earn This statistic is comparable to that of contributing factors include the less money as adults, and become Texas households overall. significant disparity in the education single parents themselves. levels of married mothers in compari- The 2010 Census showed that the The U.S. Office of Family Assistance son to single mothers and the high state of Texas and other southern (OFA) partners with state and local occurrence of insufficient child-sup- states are leading the U.S. in the rate governments and community-based port payments. of divorce. In Dallas County, about organizations to deliver responsible 60 percent of divorces involved chil- Studies have identified a significant marriage, responsible parenting and dren. Although the number of correlation between low measures of responsible fatherhood training for single-father-headed households is health, development and academic at-risk populations. These partner- on the rise, the vast majority of performance and single-parent fami- ships seek to deliver programming these, 90 percent, households are lies. Children from single-parent and support that address the under- headed by single mothers. homes are likely to exhibit emotional lying economic and sociological and behavioral problems. These issues that contribute to negative Female-headed single-parent homes problems often go undiagnosed, and outcomes for children and families. are statistically more likely to live in combined with academic challenges,

In Dallas County, about 60 percent of divorces involved children.

47 Child Support: Court-Ordered Compliance Percent of parents compliant with court-ordered child support

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percent 51 55 74 78 80 82 81 80 81 80 78

Data Source: Texas Attorney General’s Child Support Division.

In 2009, the Office of the Attorney One-fifth of Texas families who were The Texas OAG offers free manage- General (OAG) collected $281.14 authorized to receive court-ordered ment of child support, including million in child support for Dallas child support did not receive any locating absent parents, establishing County cases (OAG, 2010). Statewide payment in 2007. About half of paternity, establishing, enforcing and data shows that nearly 78 percent U.S. families with obligated child modifying child- and medical-support of the parents who were responsible support receive full payments, orders, and collecting and distributing for making payments were in compli- approximately one-quarter receive child-support payments. ance. In 2010, the OAG colle cted partial payments and about one- The child-support division of the OAG more than $2.9 billion for nearly quarter receive no payments. has more than 2,100 field employees 1.2 million cases in Texas. Guidelines for calculating the amount who directly serve the child-support Since 1990, Texas has tightened of child support are set in the Texas customers. Through 66 field offices, child-support enforcement efforts, Family Code. In general, obligators are they serve a caseload of over 1.2 and that has more than tripled the required to pay 20 percent of their million. The OAG has administered rate of paying cases, the number monthly net resources for one child, the child-support program in Texas of established paternities and the 25 percent for two children and up to for more than 25 years. collection of child support. 40 percent for five or more children.

The state collected $281.14 million in child support for Dallas County children in 2009.

48 Children Receiving TANF Average number of children receiving basic and state program benefits under the Temporary Assistance to Needy Families (TANF) program each month in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

21,778 22,514 24,705 27,357 20,445 15,342 11,495 8,973 7,242 6,351 8,137

Data Source: Texas Department of Health and Human Services, as reported by Kids Count.

TANF provides minimal cash assis- Federal and state safety-net or work- receiving TANF “assistance” in the tance for children in families that support programs provide assistance first three quarters of the fiscal year face severe economic hardship and to low-income families, usually deter- 2010 was 3,033 cases per month. have few resources. The program mined by eligibility based on the Together, these comprise 50,555 provides temporary financial, medical poverty line. In the case of TANF, eli- TANF assistance cases per month and employment assistance to fami- gibility for assistance is determined in Texas. lies with incomes below 130 percent by the state. According to the Center of the poverty level. The average for Public Policy Priorities’ 2011 TANF benefit in Texas is $200 per report, in order for children in a fam- month. More than half of the Texas ily of three in Texas to receive TANF, While 8,137 Dallas children receiving benefits are their family must make less than County children younger than 6. $2,256 annually, or 12.3 percent of received monthly the federal poverty level. Although the average number of chil- TANF benefits in dren receiving TANF benefits in Dallas According to the Texas Department of County increased from 6,351 to 8,137 Health and Human Services 2010, Texas requires (an increase of 28 percent) from Commission, in the 2010 fiscal year their families to be 2009 to 2010, these figures are sig- the average number of families in virtually destitute in nificantly lower than the number of Texas served per month (October children who received assistance in 2009-September 2010) was 47,522. order to qualify. the period between 2000 and 2005. The average case count of children

49 WIC: Special Supplemental Nutrition Program for Women, Infants and Children Number of eligible women, infants and children who received services through Dallas County WIC program

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 April NA 70,161 77,097 80,901 86,877 93,785 88,594 97,669 103,284 115,283 118,504* 109,165 Nov. 68,490 74,592 79,629 83,992 93,534 93,362 101,027 102,869 106,544 NA 113,821 NA

Data Source: Texas Department of State Health Services.

WIC provides nutritional education percent) in the number of recipients the program also provides help with and food supplements to women, who were served as of April 2011. accessing healthcare to low-income infants and children with low family women, infants, and children. Each In addition to nutrition education incomes who are at risk of poor dollar spent on WIC saves $3.07 in and counseling and nutritious foods, health outcomes. Medicaid health services during a baby’s first year. In 2011, of the 131,737 infants, women and children who were eligi- Cost-containment measures insti- ble to receive WIC services in Dallas Each dollar spent tuted by the Texas WIC program, County, 109,165 were served. on WIC saves $3.07 combined with additional federal Although the number of eligible in Medicaid health funding, has significantly increased recipients who received assistance the availability of nutritious food for increased from 79.6 percent to 89.6 services during a pregnant and breastfeeding women percent between 2008 and 2010, baby’s first year. and their children in Texas. there was a significant decline (82.9 *May 2010

50 School Lunch Program Eligibility Percent of children eligible to receive free or reduced- price lunches at schools in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Number 201,050 211,118 225,405 236,021 246,319 257,146 274,949 280,790 287,865 301,099 315,855 325,767 Percent 50.3 51.4 53.4 55.1 57.1 59.3 62.1 63.4 64.5 66.9 69.4 70.9

Data Source: TEA: PEIMS Standard Reports 2000-2011.

The percentage of Dallas County chil- for children who are economically through June 30, 2010, 130 percent dren receiving free or reduced-price disadvantaged. Children from fami- of the poverty level was $28,665 for meals has risen by nearly 38 percent lies with incomes at or below 130 a family of four; 185 percent was over the past decade, from 201,050 percent of the poverty level are eligi- $40,793). in 2000 to 325,767 in 2011. More ble for free meals. Children from families with incomes than 70 percent of all public school Those with incomes between 130 over 185 percent of poverty pay full children in Dallas County were eligi- percent and 185 percent of the price for their meals; however, they ble for assistance (either for free or poverty level are eligible for reduced- receive a certain level of assistance reduced-price lunch) in the 2010-11 price meals, for which students can toward meals. The nationwide pro- academic year. be charged no more than 40 cents. gram cost was $9.3 billion in 2008 The school lunch program provides (For the period covering July 1, 2009, (USDA School Lunch Program). free or reduced-price school meals

More than 70 percent of all public school children in Dallas County were eligible for free or reduced-price lunches in the 2010-11 academic year.

51 Subsidized Housing Units Number of housing choice vouchers (Section 8) and public housing units provided through local housing authorities for low-to-moderate-income families with children

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Total 23,481 23,481 30,933 32,105 32,433 32,428 32,428 32,461 32,461 34,114 34,114 34,108

Public Housing 4,268 4,268 5,566 5,566 5,566 5,566 5,566 5,566 5,566 4,510 4,510 4,510

Section 8 19,213 19,213 25,367 26,539 26,867 26,862 26,862 26,895 26,895 29,604 29,604 29,598

Data Sources: Texas Housing Association, http://www.txtha.co. National Low Income Housing Coalition - Out of Reach 2011 report . Fiscal Year 2010 Fair Market Rent (HUD, 2010; revised as of March 11).

Because 11.3 percent of the families Dallas County area are administered time in 11 years, with rates lower in in Dallas County earned less than by the Dallas Housing Authority and 10 of the last 12 months. The latest $25,000 annually, according to the include Balch Springs, Dallas, Garland, data from Foreclosure Listing Service, 2009 estimates of the U.S. Census’ Grand Prairie, Lancaster and Mesquite. suggests that foreclosure filings in American Community Survey, they Dallas-Fort Worth area for September Recent economic condition exacer- needed assistance with affordable 2011 were 19 percent lower than a bated the need for an increase in the housing. In 2011, there were 29,598 year ago, with rates declining for the proportion of subsidized housing. An units of subsidized housing or hous- seventh month in a row. increase in unemployment for middle ing vouchers and 4,510 units of to low-income families also led to a The 2010 Joint Center for Housing public housing allocated for residents rise in late loan payment rates. Studies at Harvard University states of Dallas County. that more than 33 percent of US In a recent Dallas Morning News arti- According to the National Low Income households spent more than 30 per- cle (August 22, 2011) George Roddy, Housing Coalition’s “Out of Reach” cent of their incomes on housing as president of the Addison-based fore- report for 2011, the fair-market rent per the 2009 measure, while 19.4 closure tracking firm Foreclosure (FMR) for a two-bedroom apartment million of these households spent Listing Service, stated that the year- in Dallas County was $891 in 2011. more than half. This number is up to-date residential postings in the from 13.8 million in 2001. Subsidized housing programs in the DFW area has declined for the first

In 2011, there were 29,598 units of subsidized housing or housing vouchers and 4,510 units of public housing allocated for residents of Dallas County.

52 Homeless Children and Youth Number of homeless children and unaccompanied youth identified in Dallas County

2005 2006 2007 2008 2009 2010 2011

1,214 1,265 1,171 1,306 1,355 1,161 1,167

Data Source: Metro Dallas Homeless Alliance (MDHA). www.mdhadallas.org

Each year, the Metro Dallas Homeless The most drastic demographic Of the homeless adults surveyed, 461 Alliance (MDHA) conducts a point-in- change occurred among Caucasian reported having a child living with time census of homeless persons in youths, whose share of the homeless them on the night of the census, a Dallas County, in order to collect population increased from 11 percent 27 percent increase from 2010. basic information about the county’s in 2010 to 21 percent in 2011. homeless population. When separated by age group, the By race and ethnicity, 61 percent of largest age groups for homeless chil- In Dallas County, homeless youth in 2011 were identi- dren in Dallas County in 2011 were 1 more than 1,160 fied as African-American, down one to 3 years and 4 to 6 years, account- percent from 2010, and the Hispanic ing for 21 and 23 percent of the children and share of the homeless population homeless child population, respec- teenagers were dropped four percentage points tively. In fact, just over half of all from 17 percent in 2010 to 13 homeless children in Dallas County in homeless in 2011. percent in 2011. 2011 were younger than 7 years old.

53 Eligible Children in Subsidized Childcare Number of Dallas County children receiving childcare services free or at a reduced price

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

20,149 21,950 24,607 24,351 25,098 26,034 25,057 25,200 20,018 23,472 27,700

Data Source: Child Care Group; naccrf.org

Subsidized child care is available to cent increase from 2008. This aged child is $6,454 in 2011, making low-income working families, parents reversed a downward trend from it comparable to the annual tuition receiving welfare who are enrolled 2007 to 2008 of almost 26 percent. and fees at many public universities in job training or who become Despite the continued economic in Texas. employed, and children in the care challenges faced by Texas and Dallas The average cost of childcare in of Texas Department of Family and County, the Child Care Assistance Dallas County can range from about Protective Services. program was able to serve 3,200 $103 to more than $200 per week. additional children in 2010. In 2010, 27,700 Dallas County chil- Consequently, low-income working dren received subsidized childcare, According to the National Association families are forced to make difficult more than any previous year, repre- of Child Care Resource and Referral decisions regarding the supervision senting an increase of 18 percent Agencies, the average annual cost of of their children and how to prioritize from 2009 and more than a 38 per- childcare in Texas for a preschool- other expenses for the household.

In 2010, 27,700 Dallas County children received subsidized childcare.

54 Head Start and Public School Pre-Kindergarten Enrollment Number of Dallas County children enrolled in Head Start and public school pre-kindergarten

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Head Start 4,170 4,259 4,259 4,259 4,259 4,399 4,259 4,259 4,259 4,259 4,403 NA Public Pre-K 11,863 13,153 14,097 14,870 15,899 16,638 17,653 18,296 18,593 19,400 19,384 20,289

Data Source: Texas Education Agency, Head Start of Greater Dallas.

In 2010, the number of children Start hopes to expand the Little enrolled in the Head Start of Greater Head Start of Scientist program to reach more Dallas program was 4,403, compared Greater Dallas had children within the next five years. to 4,259 during most of the previous Currently the program reaches more decade. 4,403 children than 1,100 of the 4,000 children enrolled in Head Start centers. Research indicates that a child’s earli- enrolled in 2010. est years of life have the greatest The Texas Education Agency advo- impact on their growth and develop- cates “high-quality early learning” ment and cognitive skills. Several to encourage kindergarten school publicly funded programs are participation. Head Start of Greater readiness for Texas children. In designed to increase young children’s Dallas has used The Scholastic Early collaboration with The University school readiness, including the Even Childhood Program for eight years in of Texas Health Science Center in Start Family Literacy Program, Early all of its classrooms across Dallas Houston (UTHSC-Houston), the Childhood Intervention (ECI), Head County. Student performance is being Education Service Centers and Start and public school pre-kinder- monitored yearly by the LAP-3 numerous licensed child care pro- garten. The number of children assessment tool. The objective of grams, including Head Start, the enrolled in public school pre-kinder- the program is to increase children’s State of Texas has been actively garten in Dallas County in 2011 was language and literacy skills. improving the standards for Early 20,289, which showed an increase of Children are observed and assessed Childhood Education, including the 71 percent from 2000 through 2010. at the beginning and end of each formulation of guidelines emphasiz- ing research-based instructional Head Start provides 3-to-5-year-olds year to evaluate the effects of the strategies, which can help preschool (whose families are at or below the program. Each year, Head Start chil- students to become “school ready.” poverty level) with developmentally dren make significant gains in these The state has committed to helping appropriate educational curricula, areas. Results consistently indicate parents choose programs based general healthcare and nutritious that children make significant gains upon quality measures validated by meals, as well as psychological in math and science subjects the Texas School Ready Certification exams and needed treatment. The because of their interactions with System (SRCS). program strongly encourages parental the Little Scientist program. Head

55 Third-Grade Reading Percent of third-graders meeting standard criteria on the reading section of standardized state tests in Dallas County public schools

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

80.7 81.5 82.9 84.0 87.0 84.5 85.6 83.8 84.5 87.2 90.4

Data Source: Texas Education Agency, Academic Excellence Indicator System.

In the 2009-10 academic year, 90 per- The Texas Assessment of Knowledge cent of Dallas County third-graders and Skills test is a rigorous testing met the standard reading criteria for program aligned with the state- the Texas Assessment of Knowledge mandated curriculum. It is imperative and Skills (TAKS) test. for third-graders to pass the TAKS reading test to be promoted to Early childhood reading success acts the fourth grade. as a pivotal benchmark to determine school success and life-long learning.

In 2009-10, 90 percent of Dallas County third-graders met standard reading criteria.

56 Students Passing All TAAS or TAKS Tests Percent of children meeting the Texas Assessment of Academic Skills or Texas Assessment of Knowledge and Skills in all five Dallas County public school districts

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

73.1 75.9 80.3 42.6 63.0 57.5 62.0 64.5 67.5 70.5 73.6

80 70 60 50 40 30 20 10 0

Data Source: Texas Education Agency, Academic Excellence Indicator System.

A review of the Dallas County sample unacceptable" schools in the Dallas assessments; the inclusion of a shows a steady increase in the per- Independent School District has dou- measure for English language learn- centage of students who passed the bled since last year, whereas the ers based on TAKS passing standards TAAS and TAKS test from 2005 to number of "exemplary" schools has and progress on the Texas English 2010. The 2002-03 school year was decreased by half. As per the report, Language Proficiency Assessment the first year that the TAKS test in a list released by the Texas System (TELPAS) reading, to measure was used. Generally, the percentage Education Agency, 33 schools a student’s English reading profi- of students passing has trended received the state’s lowest rating. ciency and progress; increasing the upward since the TAKS was intro- TAKS indicator standards for the District officials claimed that the duced, with a passing rate of nearly Academically Acceptable rating by sudden decline was due to the elimi- 74 percent in 2010. five points each for mathematics nation of a “controversial measure” and science; addition of a new com- Despite the increasing TAKS passing known as the Texas Projection mended performance indicator; and rates, a recent TV news report (pub- Measure (TPM) that had given increasing the accuracy of the annual lished on WFAA.com, July 29, 2011) schools credit for students who dropout rate for grades 7-8. said the number of "academically had failed the TAKS test, but were predicted to pass it in the future. Texas will move to an entirely new ratings system in 2013, including a According to the TEA news release new set of tests. The TAKS will be The TAKS passing of July 29, 2011, improvements to the replaced with the State of Texas current system include the addition rate was nearly 74 Assessments of Academic Readiness, of students receiving special educa- or STAAR, which is expected to be percent in 2010. tion services who were tested on the more rigorous and a better measure TAKS-Modified and TAKS-Alternate of academic performance.

57 Students with Limited English Proficiency Percent and number of students in Dallas County public schools who have limited English proficiency

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Number 82,467 86,010 92,963 95,757 97,647 97,892 100,813 105,454 110,472 116,075 117,932 121,275 Percent 20.6 20.9 22.0 22.4 22.6 22.6 22.8 23.8 24.8 25.8 25.9 26.4

Data Source: Texas Education Agency. Legislative Budget Board.

In 2011, 26 percent of the students in day is devoted to ESL instruction, an additional burden on students Dallas County public school districts which involves intensive instruction who may be already struggling with received bilingual or English-as-a- in English. acculturation issues and the inability second-language (ESL) instruction. to fully express themselves in English. According to the Legislative Budget The Texas Education Agency (TEA) In addition, schools face greater diffi- Board report published in January, provides supplemental funding for culties in working effectively with 2011, Dallas Independent School public school districts to offer bilin- non-English-speaking parents. District’s population counts showed gual education to their students if that 35 percent (or 55,025) of its more than 20 students with limited students were classified as Limited English proficiency (LEP) are enrolled One quarter of English Proficient, compared to the in any grade level in the district. state percentage of 16.9. Dallas County If bilingual education is not offered Students with LEP face many social public school in the district, ESL classes must be and educational challenges. Bilingual students receive offered as an alternative. Students students are required to follow the enrolled in bilingual education pro- bilingual or ESL same curriculum as English-speaking grams receive part of their instruction students, while at the same time instruction. in English and part in their native learning a new language. This creates language. A large portion of the school

58 College Readiness Percent of public school graduates who scored at or above the criterion score on both the TAKS exit-level, SAT, or ACT ELA and mathematics tests

2009 2010

42.3 44.1

Data Source: Texas Education Agency, District Accountability Standards Report, 2009-2010.

Previous Beyond ABC reports utilized a According to the TEA’s District proxy measure for College Readiness Accountability Standards Report, High School Graduates by counting the percentage of students the percentage of college-ready Ready for College who graduated from the Recommended graduates is defined as the percent- High School Program (RHSP) and age of graduates who scored at or 42.3 percent or the Distinguished Achievement above the criterion score on both were considered Program (DAP) to calculate how the TAKS exit-level, SAT, or ACT ELA college ready many were deemed ready for college. and mathematics tests. The Texas Education Agency (TEA) In order for an academic center to now has initiated an improved receive acknowledgment on this indi- methodology to measure the number cator, the AEC or charter must have and/or percentage of students who at least 65 percent of its examinees 2009 could be considered to be ready for scoring at or above the TSI standard. pursuing higher education. The Coordinating Board set the standard of college readiness on the According to the 2009 Texas College exit-level TAKS at 2,200 for mathe- 44.1 percent and Career Readiness Standards were considered matics, and on ELA with a score of report (published by the Educational college ready 3 or higher on the ELA essay. Policy Improvement Center in conjunc- tion with TEA and the Texas Higher According to the 2009 College Education Coordinating Board), 42.3 Readiness report from TEA, in the percent of Dallas County graduates past 10 years the State of Texas has were considered to be college-ready been very eager to ensure that stu- 2010 in 2009. In 2010, 44.1 percent of the dents are “prepared for a changing graduates were ready for college. and increasingly complex future.”

In 2010, 44.1 percent of Dallas County graduates were deemed ready for college.

59 Truancy Number of truancy filings for the school districts in Dallas County

2004 2005 2006 2007 2008 2009 2010

19,061 14,053 NA 13,401 35,184 38,695 46,043

Data Sources: The Dallas County Truancy Court.

Dallas County Truancy Courts school fall behind their peers in the by the Truancy Enforcement Center received more than 46,000 truancy classroom, which increases the likeli- return to school with no further tru- filings during the 2009-2010 school hood that they will drop out of ancy problems. year, a 19 percent increase from school. The Texas Education Code In all states, the first body responsi- 2008-09. According to court reports, requires compulsory school atten- ble for enforcing truancy laws is the number of truancy filings has dance for children ages 6-17. usually the school. School officials, steadily increased since 2007. The Truancy Enforcement Center such as school truancy officers, Truancy is highly correlated with was created to address the growing teachers and school principals, refer high-school dropout rates and often problem of truancy in the Dallas truancy cases to the appropriate is a predictor of juvenile delinquency. area. Existing juvenile justice administrative authority. However, if Police departments nationwide say practices, in collaboration with pre- truants are spotted in a public area, that students who are not in school vention and intervention services they may be detained by police or are more likely to commit crimes provided by Dallas Challenge, have taken to a detention facility. In Texas such as vandalism and shoplifting. created a unique environment and and many other states, parents can Absenteeism is detrimental to helped to get youth off the streets also be fined and jailed if they have students’ achievement, promotion, and back in school. According to the not taken reasonable steps to ensure graduation, self-esteem and employ- Truancy Enforcement Center, over 70 their child is attending school during ment potential. Students who miss percent of the youth seen each year regular school hours.

County truancy courts had more than 46,000 truancy filings in the 2009-10 school year.

60 Middle School and High School Dropout Rates Number of middle- and high-school students who dropped out of Dallas County public schools

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Total 1,705 1,584 1,694 228 2,018 1,987 7,853 7,961 6,795 5,5 05 4,777

PERCENTAGES African American 1.3 1.2 1.1 0.3 1.0 1.0 4.7 .9 4.7 3.7 3.1 Hispanic 1.3 1.2 1.2 0.5 1.4 1.3 4.6 4.7 3.7 2.9 2.5 White 5.0 0.4 0.5 0.1 0.7 0.6 2.4 2.3 1.7 1.5 1.7 Economically Disadvantaged 1.0 0.8 0.9 0.4 0.8 0.9 3.4 3.6 2.8 2.0 1.5 At-risk NA NA NA NA 1.2 1.3 4.6 4.9 3.9 3.1 2.7

Data Source: Texas Education Agency- Secondary School Completion and Dropouts in Texas Public Schools.

According to the Texas Education receive a General Educational rate in Dallas County was greater Agency, a dropout is a student who Development certificate (GED), than 72 percent. The graduation rate attends Grade 7-12 in a public school continue school outside the public reflects the percent of seniors who in a particular school year and does school system, begin college, or die. stayed in school until they finished not return the following fall, is not their senior year in high school. The percentage of students who expelled, and does not graduate, However it does not quantify the dropped out from middle school and percent of students who dropped high school in Dallas County has out prior to their senior year. It also gradually declined from 4 percent in does not reflect the number of stu- Data from the 2007 to 2.4 percent in 2010. In 2010, dents who graduated in the summer the dropout rates were highest for 2009-10 academic or winter after their senior year. African-American students at 3.1 per- year shows the cent and lowest for white students at Studies indicate that high-school senior graduation 1.7 percent. Dropout rates also have dropout rates are a good predictor of rate in Dallas declined for economically disadvan- future employment possibility, and taged students, from 3.4 percent in research shows that high-school grad- County was greater 2006 to 1.5 percent in 2010. uates are more likely to earn higher salaries than those who dropped out. than 72 percent. Data from the 2009-10 academic year shows the senior graduation

61 Licensed Childcare Slots Number of childcare slots available in state-licensed or state-registered facilities in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Total Slots 104,863 112,586 108,152 107,402 103,052 95,430 101,600 101,522 100,676 99,209 100,513

Childcare Centers 97,411 98,360 94,231 93,698 91,043 86,910 90,764 91,295 89,522 88,475 89,275 Registered Family Day Homes 7,020 13,536 13,188 12,900 10,920 7,578 9,864 9,300 9,108 8,532 8,592

Listed Homes 432 690 733 804 1,089 942 972 927 2,046 2,202 2,646

Data Source: Texas Department of Family and Protective Services, Childcare Licensing.

Nearly two-thirds of Dallas County ing relationships with caregivers, According to the 2010 U.S. Census, families have either both parents or which is one key to future success in the Dallas County population grew by the only parent working. This situa- school and as productive adults. almost 7 percent between 2000 and tion makes childcare, after-school 2010. The percentage of individuals The number of childcare centers care and summer care critical. under the age of 5 is just over 8 has declined by almost 10 percent percent, while the percentage of Quality, affordable childcare and pre- between 2001 and 2010, and the total individuals under age 18 is almost school are essential to healthy child number of slots has declined by over 30 percent. development and children’s school 10 percent for the same time period. readiness. Research clearly indicates The Child Care Licensing Division that high-quality childcare increases of the Texas Department of Family children’s language and literacy and Protective Services is responsi- development as well as their mathe- Over the past ble for protecting the health, safety matical and reasoning abilities. and well-being of children in regu- decade, the lated childcare operations. Child- Children who receive attentive, per- care permits in the form of listings, sonalized care are more likely to be availability of registrations or licenses are offered emotionally secure, socially compe- regulated childcare for different types of operations. tent and intellectually capable. They has declined. Accreditation of child-care centers, also are more likely to develop trust- however, is voluntary.

62 Licensed, Registered, or Listed Childcare Facilities Number of facilities that meet standards and are state-licensed or state-listed under the Childcare Licensing program within the Texas Department of Family and Protective Services

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

2,288 2,372 2,348 2,319 2,554 1,996 2,050 1,724 2,322 2,319 2,486

Data Source: Texas Department of Family and Protective Services, Childcare Licensing.

Although the actual number of children under the age of 15, repre- health, educational, emotional and licensed or listed facilities has senting almost one quarter of the behavioral problems. declined by almost 3 percent from a total population for the county, and Accreditation of childcare centers is 2004 high of 2,554, the number of that number is growing. voluntary. Child Care Licensing, a such facilities in 2010 — 2,486 — The majority of these children spend division of the Texas Department of still represents the second-highest at least part of each day in childcare Family and Protective Services, is over the past decade. because their parents work. Whether responsible for licensing and moni- According to the U.S. Census, Dallas center- or family-based, substandard toring all regulated childcare County is home to nearly 550,000 childcare can cause a variety of facilities.

In 2010, Dallas County had 2,486 licensed or listed childcare facilities.

63 Vaughn Washington

aughn Washington receives as much attention as a Hollywood star wherever he goes. V What makes him noticeable is simply that he is adorable.

Vaughn accepts the attention, but he is sensi- tive about his right hand. It’s hard to see why at first glance. But if you look closely, you can tell that his right thumb doesn’t look exactly like his left thumb.

That’s because his right thumb is actually a toe.

Vaughn sucked his thumb as a toddler, and his foster parent at the time thought that wrapping his thumb in duct tape would break the habit. Instead, the duct tape cut off the circulation to his thumb, resulting in gangrene. The only option at that point was to amputate the thumb.

Losing the thumb could have been devastating for Vaughn, since thumbs are vital to gripping and to performing many other everyday functions. But the experts on the Plastic Surgery team at Children’s decided to move the second toe on Vaughn’s right foot to replace his lost thumb. It was the first such transplant procedure at Children’s.

“The procedure has become fairly common in adults, but it is very rare in children,” said Dr. Michel Saint-Cyr, one of Vaughn’s surgeons. “However, we feel like in Vaughn’s case, the transplant was an absolute success.”

Within a few months after surgery, Vaughn developed a wide range of movement with his new thumb. “His mind has already accepted the toe as a thumb,” Dr. Saint-Cyr said. “So we expect it to grow and behave like any other thumb would. His thumb won’t hold him back from doing anything he wants.”

Neither will the missing toe. Vaughn does not limp at all. In fact, he runs as much as he walks.

“We are so grateful to everyone at Children’s,” said Kim Washington, Vaughn’s adoptive mother. “Vaughn is going to be able to live like nothing ever happened to his thumb now.”

64 Confirmed Victims of Child Abuse and Neglect Number of confirmed victims of child abuse and neglect in Dallas County for whom Child Protective Services provided remedial services

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

4,802 4,337 5,138 5,292 5,518 5,116 5,532 5,443 5,403 5,862 5,591

Data Source: Texas Department of Family and Protective Services, Data Books and Annual Reports, 2001-2010.

In Dallas County, the number of con- neglectful supervision. The Texas “proposed rate cuts for foster care firmed victims of child abuse and Legislature has invested in CPS and adoption payments were not neglect in 2010 declined from 2009 reform since 2005, but state funding implemented and some caseload but escalated from 2008. According remains inadequate to ensure CPS growth for these programs was to the U.S. Census, the total Dallas can effectively serve children. funded. Overall, however, the County population increased by 6.7 agency’s budget is 10 percent less In 2009, the 81st Texas Legislature percent from 2000 to 2010. However, than the estimated need. Family took steps to improve Texas chil- the number of confirmed victims of services, adoption services, and dren’s welfare by creating a task child abuse and neglect increased by child abuse and neglect prevention force to develop a strategy for almost 29 percent during the decade. were not able to be funded at ade- improving child welfare and reducing quate levels for the next biennium. It should be noted that confirmed child abuse and neglect. Legislators Such funding cuts may further victims are a function of reports of also created a committee charged skew data downward. child abuse and neglect. Therefore, with reviewing the adoption process the observed spike in the number of and developing ways to improve The Legislature also expanded the confirmed victims may be representa- the foster-care system. parenting and paternity-awareness tive of a greater awareness and program used in the health curriculum According to the Center for Public propensity to report possible inci- for public schools to include middle- Policy Priorities, the 2011 Texas leg- dents of child abuse and neglect by school students. The program allows islative budget session was “brutal” the community. for an optional expanded curriculum for most state agencies; however, on parenting skills, including child Maltreatment of children includes the Department of Families and abuse and neglect prevention, child physical abuse, sexual abuse, Protective Services, specifically Child development and relationship skills. psychological or emotional harm, Protective Services, wasn’t impaired physical and medical neglect, and as badly as others. For example,

Dallas County recorded 5,591 confirmed victims of child abuse and neglect in 2010.

65 Deaths from Child Abuse & Neglect Number of child fatalities in Dallas County resulting from abuse or neglect

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

14 21 16 12 16 17 13 31 24 29 17

35 30 25 20 15 10 5 0

Data Source: Texas Department of Family and Protective Services, Data Books and Annual Reports, 2001-2010; TexProtects.

In 2010, the deaths of 227 children deaths. However, despite that one- 1,000 children in Texas have access in Texas and 17 children in Dallas year drop, the decade’s overall trend to child-abuse prevention services, County were attributed to child shows an increase of 163 percent in versus 44 out of 1,000 children in abuse or neglect. Parents, other rela- the county’s child-abuse deaths – the rest of the United States. tives, and parents’ domestic partners five times the increase of the child According to the Texas Department of account for more than 95 percent of population over this same period. Family and Protective Services, child all perpetrators in Texas CPS cases. Experts consider the number of child deaths are reviewed by the agency deaths to be a better indicator of For Dallas County, the change repre- as well as a number of other entities actual abuse statistics than the sents an almost 71 percent decrease to include Citizen Review Teams, number of confirmed abuse reports, from 2009, which saw 29 deaths. Child Fatality Review Teams child because reporting of the latter is safety specialists, regional agency For Dallas County, the change repre- skewed by capacity restraints in the death review committees, and the sents an encouraging drop of 71 system. Currently, only 9 of every state Child Safety Review committee. percent from 2009, which saw 29

In 2010, 227 children in Texas and 17 children in Dallas County died of child abuse or neglect.

66 Child Protective Services Caseload Average number of cases assigned to each Child Protective Services caseworker per month in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

22.7 26 17.2 24.6 61.4 39.7 30.1 24.5 22.1 20.2 26.4

Data Source: Texas Department of Family and Protective Services, Data Books and Annual Reports, 2001-2010.

Texas Child Protective Services (CPS) average of 29 cases, and substitute- resources. According to the Center for caseworkers investigate child abuse care caseworkers carried an average Public Policy Priorities (CPPP), CPS reports, provide family support serv- of almost 30 cases, up from 20.7 weathered the brutal budget session ices to keep children in their homes, and 28.2 cases, respectively, in 2009. better than most other state agen- remove children when necessary, cies; however, the agency was funded The ability of CPS to effectively and then manage their legal cases at 90 percent of the estimated need. intervene in child abuse and neglect while they are in state conservator- cases is compromised by inadequate Despite the funding gap, direct ship. Each caseworker function is a delivery staff (clerical staff, workers critical part of effectively investigat- andsupervisors who provide direct ing and intervening in cases of Dallas County delivery services to clients) was child abuse and neglect. CPS caseworkers funded at a slightly higher level In Region 3, which includes Dallas through the next biennium. Alarmingly, County, investigative caseworkers averaged more though, Child Abuse and Neglect carried an average of 26.4 cases in than 26 assigned Prevention programs were cut by 44 2010. Caseloads for CPS casework- percent. CPPP suggested that the ers across the state significantly cases per month in cuts-only approach that was taken by exceed the Child Welfare League of 2010, more than the Texas Legislature means important America’s recommended size of 12 twice the recom- CPS initiatives were left underfunded, cases per month. Aggregately for and thousands of children will lose the State of Texas in 2010, inves- mended caseload. important prevention services. tigative caseworkers carried an

67 Children in Conservatorship Average number of Dallas County children in Family and Protective Services legal conservatorship

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

3,164 3,718 3,954 4,061 4,139 4,573 4,675 4,191 3,276 2,992 3,301

Data Source: Texas Department of Family and Protective Services, Data Books and Annual Reports, 2001-2010.

Child Protective Services (CPS) is 2010 number is still lower by almost unintended consequences, such as dedicated to ensuring children’s 42 percent when compared to the those made to programs for finding safety while also promoting the decade high of 4,675 in 2006. State and preparing potential adoptive integrity and stability of families. In investments in the CPS system since homes. In that there was a 30 per- some cases, however, children must 2005 have resulted in this significant cent cut made to this important be placed outside their homes tem- shift, which encourages more chil- strategy, the adoption process porarily while CPS staff members dren to be placed with relatives. may be slowed, meaning children work with the children’s families to will remain in foster care for longer The Center for Public Policy Priorities make their homes safe. These situa- periods. (CPPP) indicates that CPS weathered tions usually involve removing the Texas legislative budget session children from families that have inad- better than most other state agen- equate income, a lack of access to cies, but it still did not get funded public assistance and/or a history of In 2010, CPS had at a level that would maintain all drug abuse or crime. legal responsibility the agency’s initiatives or reduce In 2010, CPS had legal responsibility caseloads. for 3,301 Dallas for 3,301 Dallas County children who Moreover, the CPPP also suggests County children. had been removed from their homes, that some of the cuts may result in a 10 percent increase from 2009. The

68 Children Displaced by Violence Number of children served in family-abuse shelters in Dallas County

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Total 1,122 NA 1,801 NA 1,638 1,821 1,691 1,506 1,520 NA NA

New Beginnings Shelter 184 NA 270 NA 233 250 233 216 254 NA NA

Brighter Tomorrows 221 59 491 151 729 714 716 621 552 305 346

The Family Place 487 596 684 572 530 654 502 428 432 390 433

Genesis Women’s Shelter 230 NA 356 251 146 203 240 241 282 290 270

Data Source: The Family Place; Genesis Women’s Shelter.

According to The Family Place, the many ways. They may act out their opportunity to talk about their number of Dallas-area children insecurities; they may become with- experiences. Counseling about their served in 2010 increased to 433, up drawn or depressed. If moved from experience allows children to sort 11 percent from 2009. However, the school to school, they may develop through their emotions and to be decade high of 1,821 in 2005 for all social and academic difficulties. reassured that the violence was four family-violence shelters in Dallas not their fault. More than 12,000 adults received County later declined by almost 20 shelter from their abusive relation- Abused women encounter serious percent, to 1,520 in 2008. ships, and 111 women were killed in barriers to finding safety for them- In Texas, more than 196,000 domes- 2009. Statewide, family violence selves and their children when tic-violence incidents were reported in hotline programs received 179,435 negotiating their way through the 2009, according to the Texas Council calls, and 35,588 adults received law-enforcement, legal, medical, edu- on Family Violence. More than 15,900 nonresidential services as well as cational and human-service systems children received shelter in the same 15,661 children. while maintaining a job. Many victims year because of family violence. also face the added burdens of Children who are exposed to violent language and cultural barriers. Domestic violence affects children in acts can be helped by having an

In Texas, more than 196,000 domestic-violence incidents were reported in 2009.

69 Traumatic Sports-Related Injuries Treated at Children’s Medical Center Number of children treated at Children’s for sports-related injuries resulting in hospitalization

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

23 37 22 27 33 58 95 61 73 79 90

Data Source: Children’s Medical Center.

In 2010, Children’s Medical Center According to the National Federation treated 90 sports-related injuries in of State High School Associations, Children’s treated children under the age 20, repre- approximately 140,000 secondary 90 sports-related senting a 14 percent increase over school students suffer a concussion 2009 but more than a 400 percent every year nationally. In 2010, the injuries in 2010, increase from the decade low of Texas Legislature passed, and a 400 percent 22 in 2002. Governor Perry signed, one of the increase from most detailed and comprehensive Texas is a sports-crazed state, so it sports-concussion safety laws in the 2002. might not be surprising that sports nation. According to Children’s, death injuries occur most frequently in from a sports injury is rare. However, children aged 5 to 14. Such injuries the leading cause of death from a occur at the highest rates in sports sports-related injury is a brain injury. involving contact, such as football, according to Children’s Medical Center.

70 Traumatic Injuries Resulting in Hospitalization at Children’s Medical Center Number of children treated at Children’s for trauma-related injuries resulting in hospitalization

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

652 791 631 848 751 845 888 805 795 742 649

Data Source: Children’s Medical Center.

In 2010, 649 children were admitted According to the Safe Kids Dallas Area cational levels or are under-employed to Children’s for a traumatic injury, Coalition, 90 percent of unintentional are at greatest risk of injury. representing the second-lowest num- injuries to children are preventable. Most unintentional injuries occur in ber for the past decade and a 14 According to Children’s Medical Center, the summer months, when children percent decrease from 2009. approximately 14,000 children are are out of school and unsupervised. seen every year for trauma-related In 2007, by comparison, 1,944 chil- Unintentional injury is the leading injuries in the emergency department. dren in Dallas County under the age cause of death and disability for chil- of 20 were injured and treated for Traumatic injuries occur at all ages dren ages 1 to 14 in North Texas and any unintentional traumatic injury; and socioeconomic levels and in all the United States. 725 children were treated due to neighborhoods. But children whose falls alone. families live in poverty, have low edu-

Accidental trauma is the leading cause of death and disability for children ages 1 to 14.

71 Unintentional Deaths of Children: Motor-Vehicle Collisions Number and rate at which Dallas County children ages 19 and younger are killed in motor-vehicle collisions

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 54 81 60 56 59 46 37 37 40 26 28 Rate 7.9 11.7 8.6 8 8.4 6.5 5.2 5.1 5.5 NA NA

Data Source: Texas Department of State Health Statistics, Texas State Data Center, Center for Health Statistics.

The number of children killed in According to a National Highway Texas also has a graduated drivers’ motor-vehicle collisions decreased by Traffic Safety Administration report to licensing system for new drivers almost 300 percent over the decade, the U.S. Congress in 2008, motor- younger than 18 that includes a from a high of 81 in 2001 to a low of vehicle crashes are the leading cause six-month learner permit, restricted 26 in 2009 and 28 in 2010. of death for 15- to 20-year-olds. The driving after midnight and restric- fact that teenagers use new technol- tions on carrying passengers. Although two years had increases in ogy, such as mobile phones and the number of child fatalities com- Motor-vehicle collisions account for texting, at higher rates than older pared to the previous year, specifically the most fatalities in children aged people was implicated as a risk fac- 2004 and 2008, the overall trend has 2 to 14 and second-leading cause tor for younger drivers. been downward over the decade. of death in children ages 1 to 14 Several factors can be attributed to In Texas, according to the Texas in the United States, according to the decline, including efforts by child- Department of Transportation, 387 Safe Kids Worldwide. Young children safety advocates and improved drivers or passengers aged 19 and who are properly restrained in a medical technologies. under were killed in motor-vehicle safety seat have an 80 percent accidents in 2009, with 116 as the lower risk of fatal injury compared result of an alcohol-related collision. to unrestrained children.

There has been an overall trend downward for motor-vehicle fatalities of children.

72 Unintentional Deaths of Children: Drowning Number and rate at which Dallas County children ages 19 and younger died by drowning

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 12 7 10 11 689611 14 8 Rate 1.8 1 1.4 1.6 0.9 1.1 1.3 0.8 1.5 NA NA

Data Source: Texas Department of State Health Statistics, Texas State Data Center, Center for Health Statistics.

In 2010, eight children drowned in children younger than 1 year. Dallas County, representing a 75 per- Accidental drowning accounted for Eight children cent decrease from 2009, which was 28 deaths of children ages 5 to 14 in drowned in Dallas the decade high. Both 2004 and Texas in 2008. 2007 had the lowest numbers of County in 2010, Children most frequently drown in a drowning fatalities among children home swimming pool, spa, bathtub representing a 75 younger than 20 and commensurate or toilet. Parental supervision is a rates of less than 1 death per percent decrease key element that can reduce the risk 100,000 residents. from 2009. of drowning of a child. Although 90 According to Safe Kids Worldwide, percent of parents say they actively drowning is the leading cause of watch their children while around unintentional death among children water, many also acknowledge that it ages 1 to 4 and 10 to 14, and the is easy to become distracted. third-leading cause of death among

73 Unintentional Deaths of Children: Hyperthermia Number and rate of Dallas County children ages 19 and younger who died from hyperthermia

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 02021000102 Rate 0 0.3 0 0.3 0.1 0000.1 NA NA

Data Source: Texas Department of State Health Statistics, Texas State Data Center, Center for Health Statistics.

According to the Texas Department of their bodies cannot regulate their lem, because the child’s face is not State Health Statistics, two Dallas temperatures very efficiently. visible from the driver’s viewpoint. County children died as the result of Hyperthermia deaths have increased Distraction is cited as the primary rea- hyperthermia in 2010. Unofficial in recent years, ever since legislation son that parents and caregivers may media reports indicate that three mandated that infants and small chil- forget there is a young child in the children died as the result of hyper- dren in safety seats must be placed rear seat before exiting the car. It thermia in 2011, the highest number in the back seat of cars. Rear-facing is recommended that drivers always in the decade. safety seats are particularly a prob- place a purse, mobile phone, brief- According to a news release on case or other necessary item in the August 31, 2011, the National Weather back seat along with the child, so Service officially declared 2011 as that they are forced to look in the “the hottest summer on record” for Distraction is cited rear seat before leaving the car for the Dallas-Fort Worth area. The over- as the primary the workday or for any length of time. all average temperature was 90.6 for reason that parents According to San Francisco State 2011, compared to 89.2 for 1980, the University, 23 deaths of children left in second-warmest summer on record. and caregivers may hot cars have been recorded for 2011; Hyperthermia occurs when the forget there is a 49 were recorded in 2010. A study body’s temperature escalates to a young child in the published in the journal Pediatrics in dangerous level, simply stated, the rear seat before 2005 indicated that hot vehicle fatali- body becomes overheated. Children ties of young children can occur even are at greater risk for heat stroke exiting the car. when the outside temperature is as and heat-related illness because low as 70 degrees Fahrenheit.

74 Unintentional Deaths of Children: Co-Sleeping Number and rate of Dallas County children ages 19 and younger who died as the result of co-sleeping

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 13532694210 9 Rate 0.1 0.4 0.7 0.4 0.3 0.9 1.3 0.6 0.3 NA NA

Data Source: Texas Department of State Health Statistics, Texas State Data Center, Center for Health Statistics.

The Texas Department of Family and roomtobreathe.org) to educate parents A 2009 report by the Centers for Protective Services (TDFPS) reports and caregivers about the risks of Disease Control disclosed a quadru- that 177 Texas babies died due to co-sleeping. ple increase in the rate of infant accidental suffocation or strangulation strangulation and suffocation in the According to the American Academy due to co-sleeping, or sharing a fam- United States over a period of 20 of Pediatrics, parents should not ily bed. Dallas County experienced a years, with a very high correlation place their infants to sleep in an decade high of 10 co-sleeping deaths among babies who shared beds with adult bed with the parent(s), indicat- in 2009 and nine in 2010. The TDFPS their parents. Approximately 64 ing that the practice puts babies at has an ongoing campaign (www.baby- deaths of babies under the age of 2 risk of suffocation and strangulation. have been attributed to accidental suffocation or strangulation.

Dallas County had nine co-sleeping deaths of babies in 2010.

75 Child Homicide Number of Dallas County children ages 19 and younger who died from injuries purposely inflicted by another person

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 47 56 37 30 39 49 34 41 40 31 24 Rate 6.9 8.1 5.3 4.3 5.6 6.9 4.7 5.7 5.5 NA NA

Data Source: Texas Department of State Health Statistics, Texas State Data Center, Center for Health Statistics.

Homicide deaths include fatalities The decrease can be attributed to among children who we re beaten, several factors, including improved In 2010, 24 Dallas shot, abandoned to die or other- medical technologies, significant County children wise murdered. Between 2001 and reforms by the Dallas County 2010, Dallas County had an average Juvenile Department and expanded ages 19 and of 38 child homicides per year, with community-based prevention and younger were a decade low of 24 in 2010 and intervention programs targeting high of 56 in 2001. The change rep- high-risk youth. murdered. The resents a 233 percent decrease over decade’s highest the decade. child-murder toll was in 2001, with 56 children killed.

76 Runaway Reports Number of runaway reports received by the Dallas County Juvenile Department

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

1,115 1,102 950 982 954 961 1,053 1,289 1,196 997 858

Data Source: Dallas County Juvenile Probation Department, Referrals, 1999-2010; National Runaway Switchboard.

In 2010, 10,983 Texas calls were conduct and substance abuse, percent of female youth indicate reported by the National Runaway be drawn into human trafficking, they had been physically or sexually Switchboard, with more than 1,200 prostitute themselves and expose abused. Approximately 14 percent originating from the Dallas area. themselves to communicable and of runaway youth spent two months The Dallas County Juvenile Probation sexually transmitted diseases. or more on the streets before calling Department had 858 runaway reports the hotline. The National Runaway Switchboard in 2010, down 16 percent from 2009 estimates between 1.6 and 2.8 On the streets, runaway youths and 50 percent from 2007. million youth run away each year. become targets for robbery, rape It should be noted that the reported It also estimates that 47 percent or murder. They are more likely to statistics represent reports, not indi- of youth run away because of con- attempt and commit suicide, to viduals. Consequently, one individual flicts with parents or guardians; 80 engage in criminal conduct and may plausibly have more than one substance abuse, to be drawn into reported runaway incident. human trafficking, to prostitute themselves and thus expose themselves to Although the number has trended Dallas County’s sexually transmitted diseases. In fact, downward since 2007, more quality, Juvenile Probation according to a Children at Risk report, evidence-based interventions need to “The State of Human Trafficking in be considered to address the issue. Department had Texas,” an estimated one of every On the streets, runaways can be 858 runaway three children who run away will be robbed, raped, or murdered. They reports in 2010. lured into sex trafficking within 48 are more likely to attempt and com- hours of leaving home. mit suicide, engage in criminal

77 Daniel Stiegler

aniel Stiegler dreams about playing football. Visions of acrobatic catches, sideline D sprints and game-winning touchdowns appear to him in his sleep.

Those visions were close to becoming real in the summer of 2009. He was poised to become his middle school’s star wide receiver and planned to spend his summer training for the upcoming season. But first, he wanted to land a triple flip on the family trampoline.

He almost made it. But he stuck out his hand to brace himself before the third spin, resulting in a severely broken left forearm.

After that, no cast could hold his dream together. The break was going to require surgery to heal correctly.

For Daniel, this was a nightmare.

But Daniel came to Children’s, where Dr. Christine Ho was doing a study on trampoline injuries. As one of the most- renowned pediatric hand surgeons in America, she gave Daniel his best chance to heal completely.

The surgery went very well. Dr. Ho told Daniel his arm would return to full strength, though not in time for his last scheduled game of the season. Still, Daniel showed up at every practice to support his teammates.

Daniel’s team, the Irving Junior High Lions, didn’t lose a game. Their perfect record earned a spot in the city championship game and extended their schedule a couple of weeks — just enough time for Daniel to receive one last checkup.

Dr. Ho saw Daniel the day before the big game. “I think he can go back to everything he wants to do,” she said.

Daniel was only thinking about one thing. “I’m just glad I can play football again,” he said.

The next night, Daniel’s visions returned. Footballs flew his way. The crowd roared. He could even feel the weight of his helmet and shoulder pads as he led his team onto the field.

Except this time, he wasn’t dreaming.

78 Gang Members Number of young people in Dallas County who are known to be in gangs, according to the Dallas County Juvenile Probation Department

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

956 662 504 674 610 572 604 629 602 630 535

1,000

800

600

400

200

Data Source: Dallas County Juvenile Probation Department, Referrals, 1999-2010.

In Dallas County, reported gang Urban gangsterism continues to rep- sense of belonging, to substitute membership declined from 2009 to resent a source of significant attachments for family and to assert 2010 and from 2007 to 2008. violence, substance use and nar- themselves as more powerful than Additionally, 2010 was the second- cotics trafficking, as well as graffiti they might be otherwise. Allocating lowest number of self-reported gang tagging and vandalism. more resources to address gang membership for the decade. membership, especially in terms of According to the Office of Juvenile Inasmuch as gang membership is prevention, can make a favorable Justice and Delinquency Prevention self-reported, however, its prevalence impact on crime, education and (OJJDP), youth join gangs to gain a is most likely underestimated. remediation.

Urban gangsterism continues to represent a source of significant violence.

79 Children Referred to the Juvenile Department Number and rate of referrals for assessment and determination of the need for juvenile court intervention

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Number 10,706 10,483 9,626 9,793 10,584 11,070 10,803 10,996 10,504 9,654 8,229 Rate 483 449 399 402 421 439 418 432 417 378 318

Data Source: Dallas County Juvenile Probation Department, Referrals, 1999-2010.

The juvenile justice system is resents an approximate 35 percent principal juvenile justice authorities: designed to focus on the rehabilita- decrease, substantial for an urban the Texas Youth Commission (TYC) tion of youth by providing education center the size of Dallas County with and the Texas Juvenile Probation assistance and opportunities, family an approximate juvenile population Commission (TJPC). intervention, substance abuse treat- of 260,000. The new state agency will be called ment, mental health services, and It should be noted that a referral rep- the Texas Juvenile Justice Department after school programs. resents a single disciplinary episode and will be headed by an 11-member Over the last decade in Dallas (e.g., a theft); therefore, one individ- board appointed by the governor. County, the average yearly referral ual can have more than one referral. The sweeping measure also increases rate for juveniles is 10,174, with a community-based programs in defer- The 82nd Texas Legislature passed range from a low of 8,229 in 2010 to ence to prisons, meaning that some a bill that was signed into law by the decade high of 11,070 in 2005. current TYC facilities may close. Governor Rick Perry, merging the two The decrease from 2005 to 2010 rep-

Over the past decade in Dallas County, the referral rate for juveniles has trended downward and was 8,229 in 2010.

80 Commitment to the Texas Youth Commission Number of adjudicated youth subsequently committed to the Texas Youth Commission

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

273 286 247 286 212 300 320 289 190 188 129

Data Source: Texas Youth Commission; Dallas County Juvenile Probation Department.

The newly formed Texas Juvenile beginning in 2001. The new Texas high need for mental health treat- Justice Department is a super-agency Juvenile Justice Department includes ment. Almost three-fourths of the that will include the Texas Youth reforms that will increase community- youth committed to TYC had a Commission (TYC) under its authority. based programs for youth, with the moderate or high need for sub- The TYC is responsible for the reha- objective of intervention before being stance-abuse treatment. bilitation of youth committed to the committed to a TYC facility. commission by the juvenile court. According to TYC, the youth that Da llas County had 129 commit- are sentenced there “are the state’s Dallas County had ments to TYC in 2010, a 46 percent most serious or chronically delin- decrease from 2009 and a 248 quent offenders.” Statewide in 2010, 129 commitments percent decrease from the decade the median commitment age was to TYC in 2010, a high of 320 commitments in 2006. 16; 83 percent had mean IQ scores 46 percent decrease of less than 100; 44 percent were 2010 also had the fewest number of admitted gang members; and from 2009. commitments to TYC over the decade 42 percent had a moderate to

81 Research Methodology

Beyond ABC: Assessing Children’s Health in Dallas County represents the latest information available about the issues affecting children in Dallas County. What follows is a brief description of the methodology employed, data sources selected, and issues faced.

METHODOLOGY DATA SOURCES

As with years past, the compilation of this year’s For the vast majority of indicators, data were retrieved report was completed thanks to the input of a dedi- directly from the official government agencies charged cated Advisory Board. After reviewing the indicators with maintaining accurate records of events. Examples used in previous years, the Advisory Board established include such sources as the Texas Education Agency, the 61 indicators to be included with this year’s docu- Texas Department of Family and Protective Services, ment. Research associates with the University of Texas Texas Department of State Health Services Center for at Dallas Institute for Urban Policy Research then Health Statistics, and others. Because this report worked to identify th e most consistent, recent and focuses on Dallas County, the team also utilized data historical data available for Dallas County. For most from local sources when that data was more recent or indicators, this data is as recent as 2011. Where more directly germane to the intent of the indicator possible, the research team assembled data from than state level data. In limited cases where county- as far back as 2000. level data was not provided by the official agency, the need to summarize data to the county level neces- In revisiting some sources to collect current and histor- sitated some additional manipulation of data, often ical data for Dallas County, the research team found from the original sources (e.g., school districts). Finally, that source data had been updated since production for a very small number of indicators, the nature of of the 2009 report. Not uncommon with of ficial data the data forced the research team to engage in original sources, the team found instances where preliminary data collection. In those cases, additional safeguards data used in previous Beyond ABC reports had since were in place to ensure adequate and accurate been updated by the original author. In an effort to transcription of the data. ensure continuity in the computation of numbers across years, the research team asked for all indicator data to be reported by the source agencies for 2011 and all prior years. What this means for the reader is that, on occasion, data presented in the 2011 report may differ from data presented in the 2009 report. The reader can rest assured that the source of those discrepancies was typically a shift in the source agency’s calculation or reporting practices, and that data presented in the 2011 report is calculated consistently across all years.

82 Recent Studies Regarding Children’s Issues

2011 Economic Development Guide; Dallas Feeding Our Future: Growing Up Healthy 2011. http://pediatrics.aappublications.org/ Regional Chamber. http://www.dallascham- with WIC; Children’s HealthWatch 2009, content/early/2011/06/16/peds.2011- ber.org/index.aspx?id=DFWFacts The Annie E. Casey Foundation. http:// 0204.abstract 2011 KIDS COUNT Data Book: State Profiles www.aecf.org/~/media/PublicationFiles/ The Secretary’s Challenge: Connecting Kids of Child Well-Being; The Annie E. Casey WICFinalReport.pdf to Coverage; U.S. Department of Health and Foundation. http://datacenter.kidscount.org/ Gender Matters: An Analysis of the Texas Human Services, 2010. http://www.insurekid- DataBook/2011/Default.aspx State Budget 2010-2011; Dallas Women’s snow.gov/chip/chipra_anniversary_report.pdf 2011-2016 Texas State Health Plan: A Foundation. http://dallaswomensfoundation. The State of Texas Children: Texas KIDS Roadmap To A Healthy Texas; Statewide org/sites/default/files/GenderMatters_Lz.pdf COUNT Annual Data Book 2011; Center for Health Coordinating Council. http://www.dshs. Health Effects of Media on Children and Public Policy Priorities. http://www.cppp. state.tx.us/chs/shcc/reports/SHP2011-2016/ Adolescents; Pediatrics: Official Journal of org/sotc/pdf/TKC_11.pdf Adolescent Substance Use in the U.S.; the American Academy of Pediatrics, 2010. The State of the Nation’s Housing; Joint National Center for Children in Poverty, http://pediatrics.aappublications.org/ Center for Housing Studies, Harvard Mailman School of Public Health, Columbia content/125/4/756.full.pdf+html University, 2011. http://www.jchs.harvard. University, May 2011. http://www.nccp.org/ Healthy People 2020; U.S. Department edu/publications/markets/son2011/index.htm publications/pdf/text_1008.pdf of Health and Human Services, 2010. Texas’ Child Population: More Kids, More America’s Children: Key National Indicators www.healthypeople.gov/hp2020/ Diversity, More Responsibility; Center for of Well-Being, 2011; Federal Interagency Immigrant Children; The Future of Children Public Policy Priorities, May 2011. http:// Forum on Child and Family Statistics. Princeton University Brookings Institute, www.cppp.org/files/10/TexasChildPopulation_ www.childstats.gov Spring 2011. http://futureofchildren.org/ paper.pdf An Ounce of Prevention: Texans Speak Up futureofchildren/publications/journals/ Texas Health and Human Services System for Immunizations; Nidhi M. Nakra, M.P.H., journal_details/index.xml?journalid=74 FY 2007-2011 Coordinated Strategic Plan; The Immunization Partnership, September Indicators of School Crime and Safety: 2010; Texas Health and Human Services 2010. http://www.immunizeusa.org/attach- Bureau of Justice Statistics. http://bjs.gov/ Commission, 2006. http://www.hhs. ments/wysiwyg/1440/TIPPublication.pdf index.cfm?ty=pbdetail&iid=2231 state.tx.us/strategicplans/hhs07-11/ A Report on the Bottom Line: Conditions Kids’ Share 2011: Report on Federal Strategic-Pan_2007-11.pdf for Children and the Texas of Tomorrow; Expenditures on Children Through 2010; The United States Conference of Mayors Texans Care for Children, 2011. http:// Brookings Urban Institute. http://www.brook- Hunger and Homelessness Survey: A Status texanscareforchildren.org/Report ings.edu/~/media/Files/rc/reports/2011/0721_ Report on Hunger and Homelessness in Breastfeeding Duration and Academic kids_share_isaacs/0721_kids_share_isaacs.pdf America’s Cities, December 2010. http:// Achievement at 10 Years; Pediatrics: Official Living on the Edge: America’s Low Earning www.usmayors.org/ pressreleases/uploads/ Journal of the American Academy of Families; Sophia Parker, The Resolution 2010_Hunger-Homelessness_Report-final Pediatrics, January 2011. http://pediatrics. Foundation, September 21, 2011. http:// Dec212010.pdf aappublications.org/content/127/1/e137.abstract firstfocus.net/sites/default/files/Livingonthe We Can Do Better: 2011 Update; National Building Strong Systems of Support for Edge_0.pdf Association of Child Care Resource & Referral Young Children’s Mental Health; National Out of Reach Report; National Low Income Agencies, 2011. http://www.naccrra.org/publi- Center for Children in Poverty, Mailman Housing Coalition, 2011. http:// cations/naccrra-publications/we-can-do-better School of Public Health, Columbia nlihc.org/oor/oor2011/ -2011.php University, June 2011. http://www.nccp.org/ Protecting Children in Tough Economic Who Are America’s Poor Children? publications/pdf/text_1016.pdf Times; Jane Waldfogel, Columbia University & Examining Health Disparities by Race and Child Food Insecurity: The Economic Impact London School of Economics, June 16, 2011. Ethnicity; National Center for Children in on Our Nation; Feeding America, 2010. http://www.firstfocus.net/sites/ default/files/ Poverty, Mailman School of Public Health, http://feedingamerica.org/hunger-in-america/ ProtectingChildrenEconomicTimes_0.pdf Columbia University, July 2011. http://www. nccp.org/publications/pdf/text_1032.pdf hunger-studies/child-food-insecurity- Putting Children on the Express Lane to econ-impact.aspx Health Insurance, 2010, Kaiser Commission With One Voice 2010: America’s Adults and Childhood Obesity in Texas: The Costs, The on Medicaid and the Uninsured. www.kff.org/ Teens Sound Off About Teen Pregnancy; Policies, and a Framework for the Future; medicaid/ kcmy103009pkg.cfm Bill Albert, The National Campaign to Prevent Teen and Unplanned Pregnancy, Report by Abigail Arons, prepared for Statistical Briefing Book; Office of Juvenile Children’s Hospital Association of Texas, 2011. 2010. http://www.thenationalcampaign.org/ Justice and Delinquency Prevention. http:// resources/pdf/pubs/wov_2010.pdf http://www.childhealthtx.org/pdfs/Childhood www.ojjdp.gov/ojstatbb/default.asp ObesityinTexasReport.pdf Youth Risk Behavioral Surveillance Report; Substance Use and Delinquent Behavior Children’s Budget 2011; First Focus: Making Centers for Disease Control and Prevention, Among Serious Adolescent Offenders; June 2010. www.cdc.gov/yrbs Children & Families the Priority. http:// Office of Juvenile Justice and Delinquency firstfocus.net/library/reports/childrens- Prevention, December 2010. https://www. Youth Violence: Electronic Media and budget-2011 ncjrs.gov/pdffiles1/ojjdp/232790.pdf Youth Violence: A CDC Research Brief for Effects of Recession on Communities of Researchers; Centers for Disease Control The DAWN Report: Disposition of and Prevention, 2009. http://www.cdc.gov/ Color, The Henry J. Kaiser Family Emergency Department Visits for Drug- Foundation, July 2009. www.kff.org/ violenceprevention/pdf/Electronic_Aggressio Related Suicide Attempts by Adolescents; n_Researcher_Brief-a.pdf minorityhealth/upload/7953.pdf Drug Abuse Warning Network, 2010. F As in Fat: How Obesity Policies Are Failing www.oas.samhsa.gov/2k10/DAWN001/ Youth Violence National and State Statistics America, Trust for America’s Health, 2010. SuicideAttemptsHTML.pdf at a Glance; Centers for Disease Control and healthyamericans.org/reports/obesity2010/ Prevention, 2009. www.cdc.gov/Violence The Prevalence, Severity, and Distribution Prevention/youthviolence/stats_at- Federal Food Policy and Childhood Obesity, of Childhood Food Allergy in the United a_glance/index.html Robert Wood Johnson Foundation, 2010. States; Pediatrics: Official Journal of the www.rwjf.org/childhoodobesity/product.jsp?i American Academy of Pediatrics, June 20, d=55711 83 How You Can Help

To get involved or for more information on a specific issue, please contact the following organizations, and/or the local organizations listed on the Key Web Sites pages.

CHILD ABUSE/NEGLECT FAMILY VIOLENCE

Child Abuse Hotline, 1-800-252-5400 or 911 Dallas County District Attorney’s Office — Family Violence Department, 214-653-3528, Dallas Children’s Advocacy Center, 214-818-2600, www.dallasda.com/family-violence.html www.dcac.org Genesis Women’s Shelter, 214-946-HELP, Texas Association for the Protection of Children, www.genesisshelter.org 214-422-1672, www.texprotects.org National Domestic Violence Hotline at 1-800-799-SAFE Texas Council on Family Violence, 512-794-1133, CHILDREN AND YOUTH www.tcfv.org Bea’s Kids, 214-699-4800, www.beaskids.org The Family Place, 214-941-1911 (24 hour crisis hotline), ChildCareGroup, 214-631-2273, www.childcaregroup.org www.familyplace.org

Dallas Bethlehem Center, 214-428-5171, www.dallasbethlehemcenter.org HEALTH

Launch Ability, 972-991-6777, launchability.org Children’s Medical Center, 214-456-7000, www.childrens.com Rainbow Days, 214-887-0726, www.rdikids.org Asthma & Allergy Foundation of America, Texas Ready for Life (KERA), 214-740-9241, Chapter, 817-297-3132, www.aafatexas.org www.readyforlife.org Mental Health America of Greater Dallas, 214-871-2420 The Warren Center, 972-490-9055, www.mhadallas.org www.thewarrencenter.org

Volunteer Center of North Texas, 866-797-8268, www.volunteernorthtexas.org HOMELESSNESS/DISPLACED TEENS Metro Dallas Homeless Alliance, 214-670-1101, www.mdhadallas.org CRIME PREVENTION/PUBLIC SAFETY Prom ise House, 214-941-8578, www.promisehouse.org Injury Prevention Center of Greater Dallas, 214-590-4455, www.injurypreventioncenter.org

North Texas Crime Pre vention Association, SUBSTANCE ABUSE www.ntcpa.us/index.php Al-Anon/Alateen, 214-363-0461, www.al-anon.alateen.org SAFEKIDS Dallas Area Coalition, 214-456-7397, Council on Alcohol and Drug Abuse, 214-522-8600, www.safekids.org www.gdcada.org

Mothers Against Drunk Driving Victim Services Help Line, 877-623-3435, www.madd.org

84 Key Websites

LOCAL Mental Health America of Greater Dallas American Heart Association www.mhadallas.org www.heart.org AVANCE-Dallas www.avance-dallas.org North Dallas Shared Ministries American Lung Association ndsm.org www.lungusa.org Bea’s Kids www.beaskids.org North Texas Food Bank Child Trends www.ntfb.org www.childtrends.org Big Brothers Big Sisters Lone Star www.bbbstx.org Rainbow Days, Inc. Children’s Defense Fund www.rdikids.org www.childrensdefense.org Camp John Marc www.campjohnmarc.org The Arc of Dallas ChildStats.gov: Forum on Child and Family www.arcdallas.org Statistics Catholic Charities of Dallas www.childstats.gov www.catholiccharitiesdallas.org/ The Family Place www.familyplace.org FamiliesUSA ChildCareGroup www.familiesusa.org www.childcaregroup.org The Warren Center www.thewarrencenter.org Kaiser Family Foundation Children’s Medical Center www.kff.org www.childrens.com United Way of Metropolitan Dallas www.unitedwaydallas.org March of Dimes CitySquare www.marchofdimes.com citysq.org Wesley-Rankin Community Center www.wesleyrankin.org Texas Council on Family Violence Community Council of Greater Dallas www.tcfv.org www.ccgd.org Wipe Out Kids’ Cancer wokc.org Texas Department of Protective and Community Partners of Dallas Regulatory Services YMCA of Metropolitan Dallas www.cpdtx.org www.tdprs.state.tx.us www.ymcadallas.org Dallas Afterschool Network Texas Early Childhood Education Coalition YWCA of Metropolitan Dallas www.dasn.org www.tecec.org www.ywcadallas.org Dallas Area Breastfeeding Alliance Texas Education Agency www.dallasbreastfeeding.org www.tea.state.tx.us STATE Dallas Bethlehem Center Texas Health Steps www.dallasbethlehemcenter.org 211 Texas www.dshs.state.tx.us www.211texas.org/211 Dallas Children’s Advocacy Center TexProtects: The Texas Association for the www.dcac.org Asthma & Allergy Foundation of America, Protection of Children Dallas County Health and Human Services Texas Chapter www.texprotects.org www.aafatexas.org www.dallascounty.org/hhs/ National Association for the Education of Dallas Independent School District Audubon Texas Young Children www.dallasisd.org tx.audubon.org www.naeyc.org

Essilor Vision Foundation Center for Public Policy Priorities National Association of Dental Plans essilorvisionfoundation.org www.cppp.org www.nadp.org

Genesis Women’s Shelter Spina Bifida Association of North Texas National Campaign to Prevent Teen and www.genesisshelter.org spinabifidant.org Unplanned Pregnancy www.teenpregnancy.org Girls Incorporated of Metropolitan Dallas Texans Care for Children www.girlsincdallas.org www.texanscareforchildren.org National Center for Children in Poverty www.nccp.org Inclusive Communities Project Texas CHIP Coalition www.inclusivecommunities.net www.texaschip.org National SAFE KIDS Campaign www.safekids.org Injury Prevention Center of Greater Dallas www.injurypreventioncenter.org Prevent Child Abuse America NATIONAL www.preventchildabuse.org LaunchAbility American Academy of Child and launchability.org The Future of Children Adolescent Psychiatry www.futureofchildren.org Legal Aid of NorthWest Texas www.aacap.org www.lanwt.org Voices for America’s Children American Diabetes Association www.voices.org Low Birth Weight Development Center www.diabetes.org www.lowbirthweight.org

85 “Beyond ABC” Online

In addition to the material printed in this report, you can access more information about children’s lives in Dallas County and the North Texas region by visiting: www.childrens.com/about-us/leading-the-way/child-advocacy/beyond-abc.aspx The link will take you to reports (in pdf format) issued since 2008 that provide comprehensive information on the quality of life for children in Dallas and Collin counties, including:

Assessing Children’s Health in the North Texas Corridor 2010 (covering Collin, Cooke, Denton, Fannin and Grayson counties) Growing Up in Dallas County 2009 Growing Up in Collin County 2008: Executive Summary Growing Up in Collin County 2008: Detailed Findings

86 MyChildren’s

Children need primary health care when they are sick — and when they are well. We provide both at MyChildren’s. And because we have locations throughout the North Texas area, your child’s medical home can be close to where you live.

Our practice is dedicated exclusively to children. Each of our offices is staffed by physicians who are board-certified in Pediatrics; our clinical and administrative s taffs are multi-lingual; and we are affiliated with Children’s Medical Center, one of the nation’s top 10 pediatric hospitals.

Carrollton (at Furneaux Creek) Dallas (at Bachman Lake) McKinney (University Drive) Phone: 972-245-0007 Phone: 214-654-0007 Phone: 972-542-2800 3044 Old Denton Road 2750 W. Northwest Hwy. 1720 N. Central Expy. Suite 138 Suite 170 Suite 150 Carrollton, TX 75007 Dallas, TX 75220 McKinney, TX 75070 Hours: Hours: Hours: 8 a.m. to 5 p.m. Monday-Friday 8 a.m. to 5 p.m. Monday-Friday 8 a.m. to 5 p.m. Monday-Friday and 8 a.m. to noon Saturday and 8 a.m. to noon Saturday and 8 a.m. to noon Saturday (sick visits only on Saturdays) (sick visits only on Saturdays) (sick visits only on Saturdays)

Cedar Hill (at Uptown) Grapevine (at Grapevine Mills Mall) Plano (at Hedgcoxe Road) Phone: 972-293-6300 Phone: 972-691-0200 Phone: 972-608-3800 294 Uptown Boulevard 2805 E. Grapevine Mills Circle 7800 Preston Road Suite 120 Suite 120 Suite 300 Cedar Hill, TX 75104 Grapevine, TX 76051 Plano, TX 75024 Hours: Hours: Hours: 8 a.m. to 5 p.m. Monday-Friday 8 a.m. to 5 p.m. Monday-Friday 8 a.m. to 5 p.m. Monday-Friday and 8 a.m. to noon Saturday (sick visits only on Saturdays)

87 National Recognition for Children’s Medical Center

Cardiology Nephrology The Heart Center at Children’s offers Nephrology at Children’s provides a comprehensive, specialized care for spectrum of services for patients from children with congenital and acquired birth to 21 years of age with congeni- heart diseases and disorders. tal and acquired kidney-related conditions and disorders.

Endocrinology Neurology The Endocrinology Center at The Neurology service at Children’s is Children’s offers comprehensive one of the leading pediatric neurology evaluation, treatment, management divisions in the nation. The program and education for infants, children provides care for children with condi- and adolescents in all areas of pedi- tions across the neurological and atric endocrinology, including diabetes, obesity and developmental spectrum, with particular emphasis other endocrine disorders. on muscular, physiologic and behavioral disorders.

Gastroenterology Orthopaedics The Gastroenterology (GI) program at The Orthopaedics program at Children’s treats a variety of common Children’s, ranked third nationally, and complex gastrointestinal and is widely recognized as one of the hepatobiliary disorders. The program best pediatric programs in the uses state-of-the-art diagnostic and United States. Among orthopaedic therapeutic procedures to provide advanced treatment programs in North Texas, the orthopaedic experts at and research to more than 600 patients per month. Children’s treat more children with bone fractures than any other program.

Hematology-Oncology The largest program of its kind in North Pulmonology Texas and across most of the middle The Respiratory Medicine Division at United States, the Center for Cancer Children’s offers consultative serv- and Blood Disorders at Children’s is ices for diagnosis and treatment of part of a National Cancer Institute- infants, children and adolescents designated facility. The center carries out numerous with a variety of acute and chronic clinical, translational and laboratory research studies respiratory diseases. and missions related to education and advocacy.

Neonatal-Perinatal Medicine Urology The 36-bed, Level IIIC Neonatal Pediatric specialists affiliated with Intensive Care Unit (NICU) at Children’s the University of Texas Southwestern combines advanced technology with Medical Center and Children’s Medical highly trained healthcare professionals Center comprise the North Texas area’s to provide comprehensive care for most medically innovative program approximately 325 critically ill for children with urological needs. newborns annually.

2011 2011 beyond beyond a b c a

b Assessing Children’s Health in Dallas County c Assessing Children’s Health in Dallas County