Sonoma County Early Childhood Landscape Scan

Prepared for

May 19, 2020 Prepared by Sarah Katz, MPH Data Strategy Consulting [email protected]

Contents Executive Summary 4 Introduction 5 Purpose of this Report 6 First 5 Sonoma County Goals and Mission 7 Report Methodology 8 Data sources 8 Time period of Study 9 Strengths and Limitations 9 Organization of report 9 Current and Future Demographics 11 Birth Rate and Trends 11 Where are babies born in Sonoma County? 12 What percentage of births are Medi-Cal births? 13 0-5 year-olds in Sonoma County 15 Impact of COVID-19 Shelter-in-Place Order on Parents & Parenting (April 2020) 16 Impact of COVID-19 on Income 16 Emerging Family and Child Needs 17 Initial unemployment claims in Sonoma County (April 2020) 17 Early Relational Health & Development 18 Maternal and Infant Health Assessment, 2013-2015 18 Substance use diagnosis among hospitalized pregnant females 19 Preterm births 19 Mood disorder hospitalizations among women of reproductive age 20 Reports of substantiated abuse or neglect per 1,000 children 21 Children with Special Needs 21 Adverse Childhood Experiences (ACEs) 22 Family Resiliency and Neighborhoods 23 CA Strong Start Index 24 CA Strong Start Index + Families in Poverty + Communities of Color 26 Families living under 200% of the federal poverty level 28 Neighborhood resource level by race/ethnicity, 2015 29

Social and economic determinants of health: Priorities from two 2019 community health needs assessments 30 Housing & Homelessness 30 Economic Security 30 Education 30 Families with children experiencing homelessness 31 Teen Parents 31 High-Quality Early Child Care and Education 32 Children Eligible for Subsidized Care, 2017 32 Early Care Quality, 2019 32 Where Are We: Reviewing the Benchmark of Kindergarten Readiness 2016-2019 33 Kindergarten Readiness, 2019-2020 34 First 5 Focus Schools, 2018-19 34 Summary of Findings 36 Appendix 38

Executive Summary

Research has consistently shown that children’s health and healthy development is inextricably linked to family and community health. Children born into highly-resourced families and communities experience better outcomes across their lifespan than do children born into lower resourced environments. These factors, which range from the macro to the micro levels, contribute to the divergent health trajectories that young children experience, and are starkly reflected in the disparities in some Sonoma County’s youngest children. According to the 2019 National Academy of Sciences Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity report, “persistent, additive disadvantages and early adversity are significant contributors to the widening gaps. Past historical injustices continue to impact children… and create barriers for health for those who live in contexts that undermine their opportunity to reach their health potential.”

Between the years 2020-2029, approximately 4,700-5,000 babies will be born each year in Sonoma County. Demographic projections indicate a continuing, declining birthrate. In 2018, one out of every 3 Sonoma County babies were born into 15 of the County’s 99 census tracts. Most of these 15 tracts are distinguished by their high family poverty rates, fewer neighborhood resources, and a higher percentage of people of color, each an indicator of systems’ disinvestment. A review of these key indicators, along with differences in early relational health and development, family resiliency, and early childcare capacity, reveals that persistent inequities in family and neighborhood resources will likely maintain inequities in health and healthy development without targeted, coordinated and sustained investment. Some of these highest need, lowest resourced communities are in Santa Rosa (such as Taylor Mountain, Kawana Springs, Wright, Bellevue, and Sheppard), along with three census tracts in Rohnert Park, two census tracts in Sonoma Valley, and West Cotati/Penngrove and East Cloverdale.

Kindergarten readiness has long been a goal of First 5 investments. In 2019-2020, 36% of kindergarteners in Sonoma County entered kindergarten “ready to go.” Kindergarten readiness, like nearly all the outcomes reviewed for this report, is correlated with family income level and race/ethnicity. Children whose annual family income was $75,000 or more were over two times more likely to enter kindergarten Ready to Go compared to children whose annual family income was $34,999 or less, and white students were twice as likely to be Ready to Go compared to Latino students.

In addition, early data on the effects of COVID-19 and the local Shelter-in-Place (SIP) order on health and financial security in spring 2020 demonstrate an outsized impact on Spanish-speaking Sonoma County families, and people with traditionally lower wage occupations. A survey conducted by First 5 Sonoma County of almost 300 families revealed that 65% of Spanish-speaking households lost or reduced income compared to 35% of English-speaking households in roughly the first month of SIP.

Taken together, the data in this report clearly show that there are neighborhood inequities where more the majority of babies and families live, and this influences early relational health and development, family resilience, and access to high-quality early childcare. These placed-based or neighborhood inequities contribute to the stark inequities of kindergarten readiness in Sonoma County. Intentional investments in lower resourced communities will improve overall kindergarten readiness by reducing the negative conditions that set the trajectory for young children’s futures.

Introduction

In 2020, about 5,000 babies will be born in Sonoma County. About 40-45% of these babies will be Latino and about 40-45% will be white, non-Hispanic. Based on trends from the past seven years, an estimated 20% of these children will be born into a household that receives public assistance and 13% will be born into a household confronting extreme poverty. According to the California County Scorecard on Children’s Well-being, more than 1 in 3 (or 37,000 children) live at 200% of the federal poverty level (FPL) in Sonoma County.

These 2020 babies will also be born into a community with numerous strengths and assets, resulting from over two decades of investments in high quality early childhood education, health care access, family literacy, parent capacity, community engagement, healthy development, and systems change. As a result of coordinated and dedicated investment, nearly all children 0-5 years of age in Sonoma County had health insurance in 2018.1 Other Sonoma County assets include a culture of collaboration across providers and key system stakeholders, commitment and leadership of community-based organizations that serve children and families, and partnerships that maximize impact through pooled and aligned funding.2

Numerous studies reveal that children’s health and healthy development is inextricably to their family’s health and neighborhood conditions. Children who are born into highly-resourced families and communities experience better health outcomes across their lifespan than do children born into lower resourced environments. Children’s early experiences vary considerably by race, ethnicity, and family income. These inequities, driven in part by historical and current institutionalized racism, such as segregated neighborhoods, result in developmental, health, and educational gaps that solidify before children arrive at kindergarten, and can persist into adulthood.3 As a result, communities of color often have higher rates of preterm birth, infant mortality, and exposure to adverse childhood experiences, to name just a few.

For many communities, population-level inequities remain or are widening. However, investment in neighborhoods; access to high-quality healthcare for mothers and babies; high-quality early childcare and education; systems improvement, integration, and coordination; parental education; and family and community resources can improve the health and healthy development of 0 to 5 year-olds and ensure that all children enter kindergarten ready to learn.

1 U.S. Census Bureau, American Community Survey, 2018 1-year estimate, Table S2701 2 First 5 Sonoma County, 2017 Update to the 2010-2020 Strategic Plan 3 Child Opportunity Index, Early Childhood.

Purpose of this Report

The purpose of this report is to inform decision-makers as they engage in First 5 Sonoma County’s strategic planning process to determine priorities for the next three to five years. It provides the most up-to-date data and analysis on key indicators of health and development of children 0-5, their families, and the socioeconomic environments in which they are born, grow, and learn.

By looking at the totality of factors currently facing children 0-5 and their parents in Sonoma County, decision-makers will be provided with the wider perspective they need to identify the most impactful strategies to improve the health and development of Sonoma County’s youngest children.

The report examines several economic and social community indicators because these factors contribute to the divergent health and development trajectories that children experience.4 According to the 2019 National Academy of Sciences’ Vibrant and Healthy Kids: Aligning Science, Practice and Policy to Advance Health Equity report, a child’s “health ecosystem is influenced by the social, economic, cultural, and environmental factors that impact healthy development and well-being.” It is for this reason that a place-based analysis of socioeconomic and other factors influencing children’s development and health are examined.

4 National Academy of Sciences. 2019 Consensus Report: Vibrant and Healthy Kids, Aligning Science, Practice, and Policy to Advance Health Equity.

First 5 Sonoma County Goals and Mission

In accordance with the California Children & Families Act of 1998 (Proposition 10), First 5 Sonoma County invests in the community to achieve the following five goals:

1. All Children, 0-5, are Healthy & Developing Optimally 2. Parent & Caregivers are Resilient and Nurturing 3. Early Learning Opportunities are Diverse & High Quality 4. Systems of Care are Sustainable, Integrated & Coordinated 5. The Entire Community is Engaged to Support Achievement of First 5 Sonoma County goals

The mission of First 5 Sonoma County is to maximize the healthy development of all Sonoma County children from the prenatal stage through age five through support, education, and advocacy. First 5 Foundational Principles are:

● Children must be appreciated for who they are now as well as for who they will become. ● Experiences in the first five years have a critical and long lasting impact on a child’s developing brain. ● Families are their children’s first teachers. ● All children, regardless of language, culture, or special needs, have the right to access the entire spectrum of services that support their development. ● The entire community benefits from providing all children with the opportunity to reach their fullest potential. ● Early intervention and prevention services are essential investments of resources.

Report Methodology

Data sources In preparation for this report, the author reviewed a broad set of data sources in hopes of providing a comprehensive view of the challenges, resources, and environments in which families with young children live. Fortunately, there are many excellent sources of data and analyses that provide information on the demographics, demographic projections, community needs and assets specific to Sonoma County.

First 5 Sonoma County has utilized a collective impact approach to support its planning and programming. First 5 has historically utilized a broad range of indicators based on the understanding that achieving health and healthy development for young children requires many interrelated strategies and a broad view of indicators best informs these strategies.

To this end, the following local, state and national sources of data were reviewed and incorporated into this report in the hopes of better understanding the most critical current and future needs of young children and their families.

a. 2016-2019 Road to Early Achievement and Development of Youth (READY) data b. California Strong Start Index c. Sonoma County Department of Health Services vital statistics d. 2019 Sonoma County Community Health Needs Assessments for St. Joseph – Santa Rosa Memorial Hospital and Kaiser Permanente – Santa Rosa Hospital e. University of California, San Francisco Family Health Outcomes Project (FHOP) f. First 5 Sonoma County Strategic Plan Update 2017 g. 2019 First 5 Sonoma Community Indicators Report and Supplemental Report h. 2019 and 2014 Sonoma County Child Care Needs Assessment Update, Child Care Planning Council of Sonoma County i. Mothers and Babies Program Evaluation j. Sonoma County Department of Health Services, data from the Teen Parenting Program k. 2019 Sonoma County Point-in-Time Homeless Count l. Children Now Scorecard 2018 m. 2014 Portrait of Sonoma County n. U.S. Census Bureau, American Community Survey and ArcGIS ESRI Business Analyst o. California Department of Finance Projections p. California Child Welfare Project, UC Berkeley q. Bay Area Equity Atlas r. Sonoma County First 5 COVID-19 Impact on Parents & Parenting (April 2020) s. California Policy Lab, Initial Unemployment Claims (April 2020)

Additionally, research from the 2019 National Academy of Sciences report, Healthy and Vibrant Kids: Aligning Science, Practice, and Policy to Advance Health Equity, the Heckman Institute, research and data on Adverse Childhood Experiences (ACEs), other peer-reviewed literature on early childhood development and education, the Community Action Partnership Sonoma County 2019 Community Profile and Needs Assessment draft report, the Oakland Fund for Children & Youth Strategic Investment Plan 2016-2019, and the San Francisco Children and Youth Fund Community Needs Assessment were also reviewed.

Time period of Study This report was initiated in fall 2019 and finalized in spring 2020. The report utilizes the most up-to-date data available at that time. Thus, some data sources cover different time periods. The most recent data available for most sources were years 2015 through 2019. When possible, trends were identified and discussed.

Strengths and Limitations There are both strengths and limitations related to the data and methodology of this report that should be considered. Strengths include the comprehensive nature of the report and the breadth of data sources included. Viewing a broad range of indicators side by side allows decision-makers the ability to see relationships between otherwise disparate data. Providing context from numerous points of view, allows for more comprehensive findings. All indicators included in this report are valid and reliable indicators of factors that influence child development and health.

This report analyzes the Sonoma County landscape through the lens of place-based (or neighborhood) needs as well as social determinants of health and healthy development. Place-based approaches aim to address the complex challenges and opportunities by focusing on the specific social and physical environment of communities, rather than on problems faced by individuals. The strength of a place- based approach is that it can target an entire community and address issues at the neighborhood level that affect hundreds or thousands of families at one time. A social determinants of health approach is important for all people, but it is critically valuable for children, whose positive early development can improve their health and well-being throughout the life span.5

At the same time, there are limitations to this report. All data, except two indicators, pre-date the emergence of the novel coronavirus (COVID-19), the shelter-in-place public health order in March 2019, and economic and other stressors experienced by children and their families as a result. In addition, the shelter-in-place order prevented the collection of qualitative data from important stakeholders such as parents and providers. As a result, valuable information is missing, particularly parent voices and their assessment of community needs, assets, and awareness and satisfaction with available services and resources.

Organization of report This report is organized into seven sections. The first section reports on demographics and demographic projections over the next decade. The second section reviews two sources of data providing insight into the early impacts of COVID-19 and the unprecedented shelter-in-place public health orders beginning on March 18, 2020. The next three sections are organized by First 5 areas of strategic investment: Early Relational Health and Development, Family Resiliency, and High-quality Early Care and Education. Together, these investments represent the collective impact necessary to move the needle on key outcomes and ensure children’s readiness for kindergarten.

5 Satcher, David. Public Health Reports. 2010; 125(Suppl 4): 6-7.

Kindergarten readiness is an overarching long-term goal of First 5 investments. The latest (2019-2020) indicators of kindergarten readiness are presented and discussed in the next section of the report. The report concludes with a summary of the data of key findings.

Throughout the report are references to research and analysis conducted by partners at the County, State and National levels. These references are included to provide context for the local data and to identify where First 5 strategies are in alignment with local and national initiatives.

Current and Future Demographics

Birth Rate and Trends Between 2006 and 2015, the birth rate in Sonoma County and in California declined. In 2006, the birth rate was 64 births per 1,000 in Sonoma County for women ages 15-44, and in 2015, the birth rate was 54 per 1,000. California saw a similar decline from 72 per 1,000 to 62 per 1,000 during that same period.6 Based on these projections, Sonoma County will see approximately 4,700-5,000 births annually between the years 2020-2029, representing a gradual, but continuing decline.

6As cited on kidsdata.org, California Dept. of Public Health, Birth Statistical Master Files; California Dept. of Finance, Population Estimates by Race/Ethnicity with Age and Gender Detail 1990-2009; Population Reference Bureau, Population Estimates 2010-2015; CDC WONDER Online Database, Natality Public-Use Data (Aug. 2017).

Where are babies born in Sonoma County? In 2018, there were approximately 4,500 babies born in Sonoma County. One out of every 3 Sonoma County babies were born into 15 of the County’s 99 census tracts.

Of these 15 census tracts, there were 439 births in a cluster of 5 census tracts in northwest Santa Rosa (Bicentennial Park, West End, Coddington, Olivet Road, and Railroad Square), 331 births in 3 southwest Santa Rosa tracts (Wright, Bellevue, and Sheppard) and 244 births in 2 southeast Santa Rosa tracts (Taylor Mountain and Kawana Springs). It is important to note that the majority of these 15 of these census tracts have a high percentage of families living below 200% of the federal poverty level (FPL) as well as a higher than average percentage of residents who are racial and ethnic minorities. 7 A full table showing the number of births in all census tracts is in the Appendix.

7 The poverty and racial demographic data for these census tracts is explored in depth in Family Resiliency and Neighborhoods.

What percentage of births are Medi-Cal births? In 2019, 43% of births in the greater Santa Rosa area were paid for by Medi-Cal, California’s health insurance program for low-income Californians. Medi-Cal usage is considered a proxy for poverty. The greatest number (n=292) and overall percentage of births (55%) that were paid for by Medi-Cal were in zip code 95407 (southwest Santa Rosa), followed by 183 Medi-Cal births (46% of all births) in zip code 95401 (northwest Santa Rosa). The northern portion of Santa Rosa (zip code 95403) and Cloverdale/Geyserville had the next largest percentage of births paid for by Medi-Cal (40% in both communities), followed closely by the Russian River Area (39%), Healdsburg (38%), and Sonoma Valley (35%).

In 2019, more than 1 in 3 births were paid for by Medi-Cal in several Santa Rosa communities, Cloverdale & Geyserville, Healdsburg, the Russian River area, and Sonoma Valley.

Figure. Map of Sonoma County regions by aggregated zip codes

0-5 year-olds in Sonoma County In 2020, there are approximately 27,000 0 to 5 year-olds in Sonoma County. Almost half (46%) of these children (or 12,500) are 0-2 years old, and about 35% (or 9,400) are 3 to 4 years old. Based on birth trends, the projected number of 0-5 year-olds in Sonoma County will decline to 24,000 by 2023 and to 23,000 by 2029.8

Based on projections prior to COVID-19, an estimated 6,300 kindergartners will enroll in public school in Sonoma County in 2020-2021. This number is projected to decrease to 5,300 in 2024-25 and then continue to decrease to 4,900 in 2028-2029.9 As you will see discussed in the section on high-quality early childcare, the projected reduction in incoming kindergartners does not close the gap between the need for high quality childcare and education and current community capacity.

8 CA Department of Finance, Total Estimated and Projected Population for California Counties: July 1, 2010 to July 1, 2060 in 1-year Increments 9 CA Dept. of Finance, Demographic Research Unit, January 2020, Excludes CEA and special schools.

Impact of COVID-19 Shelter-in-Place Order on Parents & Parenting (April 2020)

In April 2020, First 5 Sonoma County conducted a countywide survey seeking to understand the challenges and needs of parents sheltering in place with their young children, in compliance with state and local orders to prevent the spread of COVID-19. Two-hundred and eighty three (283) survey responses were received. Nearly 6 in 10 respondents had children under 5 years of age and nearly 8 in 10 had multiple children in the household. Nearly 2 in 3 parents responded to the survey in English, and 1 in 3 parents responded to the survey in Spanish.

Impact of COVID-19 on Income

With regard to economic impact at the time of data collection, 46% of households had at least one parent who had either lost their job or experienced a reduction in income as a result of COVID-19, with 65% of Spanish-speaking households experiencing lost or reduced income compared to 35% of English- speaking households.

Emerging Family and Child Needs The survey invited open-ended responses about the needs parents were experiencing both in relation to themselves and in relation to their children. Thirty-one percent of all respondents identified money as a need. Of those, over 70% provided a specific description of the financial need they were confronting. Typical narrative responses included “money for food,” “money for rent,” or “financial help since my hours are drastically reduced.” Almost half of the responses included the need for parenting support Forty-seven percent (47%) referenced their own mental health connected to their role as parents. Some statements included “parenting support - time and place for myself,” “stress relief, parenting support,” and “mental health/counseling for parenting support.”

Parent responses regarding the resources or support needed to care of their children varied greatly between English-speaking parents and Spanish-speaking parents. English-speaking parents most frequently identified “activities” for their children (online, outdoor, educational, etc.) as the primary need. In contrast, Spanish-speaking parents identified basic needs, such as diapers and food, as the highest priority. The difference in the identification of needs is aligned with the disparity in employment status and impact on household income of each group.

Initial unemployment claims in Sonoma County (April 2020) In April 2020, the California Policy Lab conducted an analysis of initial unemployment claims. Between March 15, 2020 through mid-April, 18.5% of the Sonoma County labor force (approximately 49,000 workers) filed an initial unemployment claim. An analysis of these claimants at the State level indicates the following trends:

● Younger workers (25-34 years) and lower-educated workers (people with a high school diploma or less) made up a disproportionately large share of initial unemployment insurance claims. ● Of the 14.4% of the California labor force that filed initial unemployment claims, nearly 1 in 3 were Food and Accommodation workers and 1 in 5 workers worked in Retail. ● Almost 90% of all initial unemployment insurance claimants during the surge of claims in the first two weeks of April reported that they expected to be recalled to their previous employers, compared to 40-50% of claimants during February.10

Initial data on the effects of COVID-19 and the local SIP order on health and financial security demonstrate an outsized impact on the poorest and most vulnerable Sonoma County families. This trend is also seen across the key indicators in the following sections of the report.

10 California Policy Lab, New Analysis of Unemployment Insurance Claims in California Provides Detailed Snapshot of COVID-19's Impact on Workers, April 30, 2020.

Early Relational Health & Development

Early relational health is dependent on the health of the mother, family, and community prior and immediately following birth. To better understand the factors influencing the health and development of young children, prenatal and postpartum maternal outcomes were reviewed, along with other early life outcomes and factors that influence early relational health and healthy development.

Maternal and Infant Health Assessment, 2013-2015 The Maternal and Infant Health Assessment (MIHA) is an annual, statewide-representative survey of women with a recent live birth in California. MIHA collects self-reported information about maternal and infant experiences and about maternal attitudes and behaviors before, during and shortly after pregnancy.11 The most recent MIHA data is from 2013-2015. During these years, about 49% of births in Sonoma County were covered by private insurance, and 47% were covered by Medi-Cal. Women who had Medi-Cal births reported greater likelihood than women who had private insurance to experience the following challenges:

a) food insecurity during pregnancy (about 1 in 4) b) inadequate weight gain during pregnancy (about 1 in 5) c) prenatal depressive symptoms (1 in 5) d) physical or psychological intimate partner violence during pregnancy (~11%) e) a job loss or partner’s job loss during pregnancy (13%) f) two or more hardships during childhood (~36%) g) lower daily folic acid use month before pregnancy (nearly half the rate, 28% vs. 50%)

Both groups of women were about equally likely to experience postpartum depressive symptoms.

11 For the complete MIHA Sonoma County 2013-15 report: https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/CDPH%20Document%20Library/2013- 2015/SnapshotCo_Sonoma_2013-2015_MaternalCharacteristics.pdf

Substance use diagnosis among hospitalized pregnant females Risk factors for substance use include the following: response to loss; neglect or sexual or physical abuse; mental illness in the family; genetic predisposition; family dysfunction; adverse school conditions; social deprivation (unemployment, poverty, homeless); exposure to traumatic event; access to alcohol and other substances including illicit and prescription drugs.

The graph below shows the rate of substance use diagnosis per 1,000 hospitalizations of pregnant females age 15-44 from 2004 to 2015.12 This rate has increased significantly during the time period in both Sonoma County and California. During this time period, Sonoma County had a significantly higher rate than California. In 2015, the Sonoma County rate was 38 per 1,000 (about 140 admissions) and the California rate was 21 per 1,000 hospitalizations.

The Sonoma County rate was highest African American women (78 per 1,000, or 20 admits), second highest among white women (50 per 1,000, or 98 admits), and lowest among Latina women (19 per 1,000) and Asian/Pacific Island women (16 per 1,000) (data not shown).

Preterm births Risk factors for preterm birth include the following: use of tobacco, alcohol or other drugs during pregnancy, low pre-pregnancy weight or low weight gain during pregnancy, vaginal infections, domestic violence, prior preterm birth, short interpregnancy interval, multiple gestation, and stress during pregnancy.

12 Ibid.

Preterm births13 and low birth weight can increase the infant’s risk of death in its first few days of life, and lead to devastating and lifelong disabilities for the child. Primary among these are visual and hearing impairments, developmental delays, and behavioral and emotional problems that range from mild to severe.14

In 2016, there were 360 preterm births among Sonoma County women. The percentage of preterm births in Sonoma County was statistically similar to California in 2016 (7.9% and 8.6%, respectively). White, Latina, Black/African American, and Asian/Pacific Islander women had statistically similar rates in the most recent time period.15

Mood disorder hospitalizations among women of reproductive age Risk factors for mood disorder hospitalizations among women of reproductive age include the following: adolescent development; response to loss; neglect, sexual, and/or physical abuse; mental illness in the family; family dysfunction; adverse school conditions; social deprivation (unemployment, poverty, homeless); traumatic event; and, alcohol and/or substance abuse including illicit and prescription drugs.

The graph below shows the rate of female (age 15 to 44) admissions with a mood disorder diagnosis per 100,000 population 2004 to 2015.16 This rate has increased significantly during this time period in both Sonoma County and California. From 2004 to 2008 and 2013 to Female admissions with a mood disorder diagnosis 2015, Sonoma County had a per 100,000 population age 15 to 44, Sonoma significantly higher rate than County and CA, 2004 to 2015

California. In 2015, the Sonoma California Sonoma County County rate was 1,360 per 100,000 1,600 (949 admissions) and the California 1,359.6 rate was 1,117 per 100,000. 1,400 1,200 1,067.5 In 2015, the Sonoma County rate 1,000 1,125.4 was highest among white women 800 902.2 (1,693 per 100,000, or 657 admits) 600 and African American women 400 (2,576 per 100,000, or 26 admits) 200 and lowest among Latina women 0 (778 per 100,000) and 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Asian/Pacific Island women (459 per 100,000) (data not shown).17

13 Births less than 37 weeks gestation 14 Healthy People 2020 indicators. https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi- topics/Maternal-Infant-and-Child-Health 15 UCSF Family Health Outcomes Project data. 16 On October 1, 2015, the classification of diagnoses and procedures changed from ICD-9-CM to ICD-10-CM. As a result, the data for 2015 includes only the first 9 months of the year. 17 UC San Francisco, Family Health Outcomes Project

Reports of substantiated abuse or neglect per 1,000 children Research shows that child maltreatment is associated with adverse health and mental health outcomes in children over their lifetime. Ensuring safe, stable, and nurturing environments for children promotes their ability to learn, and lifelong well-being.18

In 2017, the rate of child maltreatment substantiations in Sonoma County was highest in children under 1 year (16.2 per 1,000 children 0-5). The rate in Sonoma County children 1-2 years and 3-5 years was nearly 3 times lower. The California rate among children under 1 is higher than 1-2 and 3-5 year- olds as well, but Sonoma County has slightly lower rates.19 In Sonoma County, Black (20.7 per 1,000) and White children (9.3 per 1,000) had the highest rates of child maltreatment substantiations in 2017. Investments to prevent child maltreatment should target families with babies under 1 year of age.

Child maltreatment substantiations, per 1,000 Children (ages 0-5), Sonoma County, 2017

Asian/Pacific Islander 0.0

Latinx 5.8

Native American 6.1

White 9.3

Black 20.7

3-5 years 5.1

Age group and race/ethnicity 1-2 years 5.4

< 1 year 16.2

0.0 5.0 10.0 15.0 20.0 25.0 incidence per 1,000 children (ages 0-5)

Children with Special Needs According to the Sonoma County Child Care Needs Assessment from 2019, there are 135 infants with Individual Family Service Plans (IFSP) and 1,000 preschoolers with IFSPs or Individualized Education Plans (IEPs). The number of children with special needs typically increase as children get older, primarily due to higher rates of identification and diagnosis.20

18 First 5 Sonoma County: Community Indicators Snapshot 2019 19 Ibid. Data source: CA Child Welfare Indicators Project, UC Berkeley 20 Sonoma County Child Care Needs Assessment 2019 Update. Data regarding children with special needs comes from Sonoma County SELPA, the North Bay Regional Center, and the California Department of Education.

Adverse Childhood Experiences (ACEs) Adverse childhood experiences (ACEs) is the term used to describe various types of abuse, neglect and household dysfunction that occur to children under the age of 18. ACEs have been linked to toxic stress in children and adults, resulting in biological changes, altered development, learning and health challenges in children, adult chronic conditions, and early death. As the number of ACEs increase, so does the risk for these outcomes. There are three types of ACEs: abuse (physical, emotional, and sexual), neglect (physical and emotional), and household dysfunction (incarcerated relative, domestic violence, divorce or separation, substance abuse, and mental illness).

A growing body of research seeks to quantify the national prevalence of ACEs among children. In a nationally representative non-clinical sample using data from the 2011-2012 National Survey of Children’s Health, approximately 33% of children aged birth to 17 in California experienced one or two ACEs, and 9% experienced 3 or more. Preventing ACEs and identifying ACEs early among children 0-5 has the potential to disrupt the toxic stress associated with ACEs and prevent additional ACEs. Because wide ranging mental health consequences can be attributed to adverse childhood experiences, supporting families to develop positive relationships with children and address any early problems contributes to future positive mental health and well-being for caregivers and their children. The ACE pyramid below is from the Centers for Disease Control and Prevention, illustrating the mechanisms through which ACEs influence health and well-being .throughout the lifespan.

Family Resiliency and Neighborhoods

Photo credit: Child Opportunity Index

According to the 2019 National Academy of Sciences report Healthy and Vibrant Kids, children’s well- being and life course outcomes are strongly related to family income and that given this evidence, “an important factor in reducing health disparities in early childhood is to ensure that families with young children have adequate resources.” If parents and caregivers have adequate resources, they are more likely to have reduced economic stress, which can reduce caregiver stress and help caregivers care for children and “serve as buffers against adversity” for their children. Neighborhoods are important because they influence access to many critical conditions and resources for healthy child development, such as quality schools, safe places to play, and adequate income and good jobs for the adults in their lives.21

For these reasons, this section of the report reviews an assessment of the economic circumstances and neighborhoods in which families with children live, along with other challenges parents and caregivers face (such as family, health, service needs; parenting as a teen; and, homelessness) that may impede or support family resiliency.

21 Child Opportunity Index, Neighborhoods.

CA Strong Start Index The California Strong Start Index helps us understand the conditions into which babies are born. The Strong Start index uses information on family, health, service, and financial assets – such as healthy birth weight, parental education level, and ability to afford and access healthcare that are available on every birth record – to develop a Strong Start score for every child. The 12-indicators that make up the index are restricted to person-level birth record data. The Strong Start Index facilitates the identification of communities in which children have fewer assets at birth and where additional services and supports are needed to promote equity and improve child health and well-being outcomes.

In 2016, about 15% (n=850) of Sonoma County babies had seven or fewer of the 12 assets identified in the California Strong Start Index.22 Downtown Santa Rosa had the lowest mean Strong Start score in the county with an average of 8.2 assets (out of a total of 12 possible assets) for the 33 babies born in downtown Santa Rosa in 2016.

Four major regions of Sonoma County contained census tracts that rate 40% or below of the mean Strong Start score. These tracts are clustered in Santa Rosa (predominantly in southwest and southeast, and along Hwy 12, with a pocket in downtown and northwest Santa Rosa), and census tracts in Sonoma Valley, Rohnert Park, and Guerneville (map below). These census tracts and their corresponding Strong Start score are listed in the table below.

Census tracts in the bottom two quintiles (40%) of Strong Start scores in California, Sonoma County, 2016 # of Births Mean Strong Start Census Tract (2016) Score (2016) Downtown Santa Rosa 33 8.2 Sheppard 100 8.4 Boyes Hot Springs West/El Verano 67 8.4 Comstock 82 8.6 Rohnert Park A Section 56 8.7 Arnold Drive/East Sonoma Mountain 14 8.7 Roseland 67 8.7 Taylor Mountain 144 8.7 Bellevue 136 8.7 West End 75 8.8 Fetters Springs/Agua Caliente West 71 8.8 Bicentennial Park 110 8.9 Miwok 45 8.9 Hessel Community 27 8.9 Guerneville/Rio Nido 31 8.9 West Cotati/Penngrove 71 8.9 McKinley 65 8.9 Roseland Creek 76 9.0 Railroad Square 97 9.0

22 To learn more about the California Strong Start Index, visit: https://strongstartindex.org/

Spring Hill 41 9.0 Downtown Rohnert Park 75 9.0 Two Rock 38 9.0 East Cotati/Rohnert Park L Section 46 9.0

California Strong Start Index: shaded census tracts are communities with mean Strong Start scores in the lowest two quintiles in California, 2016

These data can be used to inform local planning and guide equitable resource allocation towards babies who have fewer Strong Start assets at birth to improve child outcomes at a population level.

CA Strong Start Index + Families in Poverty + Communities of Color

Along with the assets a baby is born with at birth, the level of poverty in communities influence a child’s health and healthy development.

In 2017, an estimated 14% of Sonoma County’s children under 5 were below the poverty level. 23 Poverty can impact a child’s academic performance, and the achievement gap starts early. In a 2016 report titled The Condition of Education, the National Center for Education Statistics attributed living in poverty during early childhood to lower levels of academic performance beginning in kindergarten. For some children, particularly low-income children, we see more benefits when investing from birth, instead of beginning in preschool.24 Along with higher poverty communities, communities with more people of color often experience disinvestment or diverting of resources, and experience institutional racism through educational, criminal justice, medical, financial, and other systems. This may manifest in poorer funded schools and reduced access to health and other educational supports.

The Figure below shows an overall ranking of the Strong Start Score, families living in extreme poverty (under 100% FPL), and the percentage of residents who are people of color (or non-white residents). The 22 highest need, lowest resourced census tracts, with an overall ranking of 10, 11, or 12 are in the Figure below. A complete table with all census tracts is in the Appendix.

In the Figure, each census tract has an overall ranking (12 represents the most at-risk), the estimated percent of families in poverty and communities of color, and the corresponding ranking (1-4). The overall ranking can guide strategic investment in neighborhood resources and supports for early childhood development and health.

In 2016, Taylor Mountain had the highest overall ranking and over 100 births, with a mean Strong Start score of 8.7 assets, an estimated 14% of families in extreme poverty, and an estimated 66% of residents were people of color. This is a critical area to invest supports for young families and infants, toddlers, and preschool-age children.

In 2016, there were 7 census tracts where 100 or more babies were born. Five (Taylor Mountain, Wright, Bellevue, Kawana Springs, and Sheppard) were in the top 10 census tract with the worst overall rankings. In the poorest performing quartile in terms of overall ranking, most census tracts were in Santa Rosa, then Rohnert Park (Downtown Rohnert Park, Rohnert Park A Section, and Rohnert Park B/C/R Section), Sonoma Valley ( Fetters Springs/Agua Caliente West and Boyes Hot Springs/Fetters Springs/Agua Caliente East), West Cotati/Penngrove, and East Cloverdale (Figure on the next page).

23 First 5 Sonoma County Strategic Plan supplemental indicators. 24 Heckman Alliance Briefing.

preschoolers.

Families living under 200% of the federal poverty level Children who are born and raised in poverty are at higher risk for poor health outcomes, problems in early development (e.g., lack of readiness for kindergarten, diagnoses of developmental delays and/or disorders), and higher rates of most childhood chronic conditions (such as mental illness, developmental disabilities, obesity, and asthma). While the Strong Start Index table in the previous section examined families with children living below the federal poverty line, because of the high cost of living in Sonoma County, we examine families living under 200% FPL in this section to better understand families living with economic stressors that may impede young children’s ability to thrive.

The table to the right lists the estimated number and percent of families with children under 18 years of age living at or below 200% FPL. The table lists the 27 census tracts where 40% or more of families with children were living below 200% FPL in 2018.

Fifteen census tracts had an estimated 50% or more of families with children living under 200% FPL in 2018. Eleven of these census tracts were in the greater Santa Rosa area, and the other four were East Cloverdale, Monte Rio (West Sonoma County), McKinley (Petaluma), and Gold Ridge (West Sonoma County).

There were four census tracts (Wright, Taylor Mountain, Bellevue, Comstock; all in the greater Santa Rosa area) where there were more than 1,000 families with children living under 200% FPL. East Cloverdale (with about 679 families with children living under 200% FPL) was the only census tract in the top 10 that was not in the greater Santa Rosa area.

Neighborhoods in Santa Rosa and East Cloverdale have the highest percentage of families with children living below 200% FPL

Neighborhood resource level by race/ethnicity, 2015

According to the Bay Area Equity Atlas, in an equitable region, access to opportunity-rich neighborhoods would not vary by race. However, in the Bay Area and in Sonoma County, people of color are less likely to live in the highest resourced communities than white people. In Sonoma County, 10% of people of color lived in high or the highest resourced neighborhoods, compared to 21% of white people in 2015. Latinos and Native Americans (65%) were most likely to live in low resource neighborhoods compared to 36% of whites (Figure below).

In 2015, people of color were almost twice as likely to live in a low resource neighborhood than whites in Sonoma County

Social and economic determinants of health: Priorities from two 2019 community health needs assessments The 2019 Community Health Needs Assessments (CHNA) conducted by the Kaiser Foundation Hospital - Santa Rosa and St. Joseph – Santa Rosa Memorial Hospital also identified lack of financial, educational and other resources as the drivers of poor health outcomes for the County’s children and adults. The CHNA identified three community health priorities - housing and homelessness, education, and economic security - as the necessary areas of focus and investment to change the course of community health outcomes. An overview of the CHNAs findings on each priority area is presented below: Housing & Homelessness “Sonoma County’s high cost of living exacerbates issues related to health care access and affordability. More than half of renters in the county spend 30 percent or more of their income on rent…There is also strong regional variation in home prices: Rohnert Park is the most affordable area with a median home selling for $479,500, compared to Healdsburg, which is the least affordable with a median home price of $804,000. The burden of housing costs exacerbates disparities; for example, Latino families in Sonoma (with median household incomes of $55,675) fall below the minimum qualifying income for a median price home in the county ($112,840). Additionally, homelessness exposes individuals to increased health risks on a variety of measures, and service providers have difficulty getting those experiencing chronic homelessness both off the street and into a continued care arrangement… Focus group respondents reported that money spent on rent impedes their ability to afford preventative and urgent medical care. These issues were exacerbated by the October 2017 Sonoma Complex Fires, which both destroyed homes, and increased unemployment among the most disadvantaged.” Economic Security “Economic security means having the financial resources, public supports, career, and educational opportunities necessary to be able to live one’s life to the fullest. As such, this health need touches on every other health- related issue in the Santa Rosa community, from mental health to housing. While Sonoma County has slightly less economic inequality than California as a whole, there is significant racial and regional variation along economic measures. Child poverty…is especially high among Native American/Alaska Native (23%), Hispanic/Latino (19%) and Black (14%) community members in the Santa Rosa service area. Non-Hispanic Whites in the county have higher wages and rates of business ownership… Community members voiced in focus groups that inequity between high- and low-income areas impacts community cohesion and leads some to feel underrepresented in political discussions, which can impact economic and health policy.”

Education “Education directly impacts a person’s ability to live a long and healthy life… While some education outcomes are better for Sonoma County than the rest of California, only half of children in the Santa Rosa service area attend preschool and two-in-five adults in the county lack a college education.1 In addition to the need for progress on these standard benchmarks, strong racial inequities persist in the educational system…The proficiency gaps for literacy and math seen between Hispanic/Latino and non-Hispanic White students in the early grades persist throughout secondary school. For example, 60 percent of White 3rd graders earn proficient scores on literacy tests compared to only 30 percent of Hispanics…1 Focus group participants also expressed a desire for career and technical training to meet workforce needs, and felt classes on financial literacy and sexual health would particularly benefit the most disadvantaged residents.”

Families with children experiencing homelessness According to the 2019 Sonoma County Homeless County, “national data from 2017 suggest that 33% of all people experiencing homelessness are persons in families” and that the majority of homeless families nationally are households “headed by single women and families with children under six.” The 2019 Sonoma County Homeless Count states that children in families experiencing homelessness have increased incidence of illness and are more likely to have emotional and behavioral problems than children with stable living conditions. In 2019, there were 87 families with 279 members experiencing homelessness. The primary cause of homelessness among families was eviction (32%), up from 19% in 2018 and 4% in 2016.25

Teen Parents In Sonoma County, teen birth rates have decreased A snapshot of teen nearly 50% in the past six years and by over 63% since 2000-2002. The decrease in teen birth rates has parents decreased equally for Latina teens and white, non- Teen Parent Connections (TPC) is a program Hispanic teens, but the disparity between the two in Sonoma County that has been serving groups remains. Teen birth rates were 4 times higher pregnant and/or parenting teens since among Latinas than white, non-Hispanics (18 vs. 3 per 1987. TBC utilizes a whole person approach 1,000 females 15-19 years in 2015-17). While about 12% to address the complex health risk for teen of total births in Sonoma County (2014-16) were to mothers and their children. mothers who lived in zip code 95407 (southwest Santa Rosa), almost 40% of teen births were to mothers who Of teens referred in 2018-19 to TPC, over lived in this zip code.26 50% of them lacked parental support due to a variety of factors, such as:

• childhood neglect and abandonment, • parental deportation and incarceration, • parental drug abuse and mental health conditions, • and a history of child abuse.

25 2019 Sonoma County Point-in-Time Census 26 Teen Parent Connections February 2019, Sonoma County Department of Health Services

High-Quality Early Child Care and Education

High quality, culturally-appropriate early care and education (ECE) can improve children’s cognitive and socio-emotional development and academic readiness, as well as affect other child health outcomes, including physical, emotional, and mental health. According to the 2019 National Academy of Science Healthy and Vibrant Children report, “ECE programs increase children’s cognitive, social, and health outcomes through enhancing their motivation for school and readiness to learn and the early identification and intervention of problems that impede learning. This, in turn, helps children improve their cognitive ability and social and emotional competence, while increasing their access to and use of preventive health care.” In this section, we present information on the demand and supply of subsidized ECE and the quality of ECE in Sonoma County.

Children Eligible for Subsidized Care, 2017 According to the Sonoma County Child Care Needs Assessment 2019 Update, about 3,100 infants (<2 years) and 4,700 preschoolers (2 to 4 years old) were eligible for subsidized child care and development in 2017.27 In 2018-19, about 445 infants were enrolled in some form of subsidized care, representing 14% of total demand. This left a gap in needs for 2,600 additional slots. At the same time, about 3,100 preschoolers were enrolled in subsidized care representing sixty-five (65%) of total demand. This left a gap in needs for an additional 1,600 preschool slots.28 In 2019, the Sonoma Valley Education Foundation’s For more information on the demand and supply for Preschool Working Group and other subsidized and unsubsidized care, including the stakeholders assessed access, quality, and equity within varying levels of demand met for infant and preschool programs in Sonoma Valley. The study was preschooler childcare slots in Sonoma County intended to assist Sonoma Valley Unified School District neighborhoods, see the 2019 Child Care Needs (SVUSD) and the community to better understand the Assessment for Sonoma County. current state and future needs of preschool education in Sonoma Valley. The study found that ~70-80% of children received some preschool experience before enrolling in Early Care Quality, 2019 kindergarten at SVUSD but reported that many preschools did not utilize an evidence-based scope and Research shows that quality early learning programs sequence curriculum, and most are tuition-based. For can improve young children’s development, enhance more information, see the Sonoma Valley Preschool school readiness, help close the achievement gap, and Study Report. improve children’s social-emotional and cognitive outcomes.29 As of January 2019, 39% (or 59 of 150) licensed child care centers and 10% (or 34 of 324) licensed family child care centers participated in Quality Counts, a statewide and county-level initiative that helps promote quality in early care and education settings. All sites that have been rated are either Tier 4 or 5 (the highest ratings).

27 This analysis used Labor Force Participation Rates for children in households with two working parents and the number of families earning less than 85% of SMI. 28 2019 Child Care Needs Assessment for Sonoma County. 29 2017 Update: First 5 Sonoma County Strategic Plan

Where Are We: Reviewing the Benchmark of Kindergarten Readiness 2016-2019

In the previous three sections, we looked at a broad range of community indicators related to early relational development and health, family resilience and neighborhoods, and high quality early care and education (ECE). Together, these indicators point to what is still needed to move the needle on key health outcomes and ensure children’s readiness for kindergarten. Kindergarten readiness has long been the benchmark of optimal development and the long-term goal of all First 5 investments. Children who enter school with early skills, such as basic knowledge of math and reading concepts as well as communication, language, social competence and emotional maturity, are more likely than their peers without such skills to experience later academic success, attain higher levels of education, and secure employment.30

In this section, we will examine the most recent data on Sonoma County children’s readiness for kindergarten. Based on our understanding of the close connection between neighborhood resource levels and health, education and financial outcomes, we will pay special attention to needs among the First Five “Focus Schools” where the majority of the County’s socioeconomically disadvantaged and dual language learners attend elementary school.

30 First 5 Sonoma County: Community Indicators Snapshot, 2019

Kindergarten Readiness, 2019-2020 The Kindergarten Student Entrance Profile (KSEP) is a 12-item observational screening tool that gathers information about the social-emotional and academic domains of school readiness. During the first four weeks of the school year, teachers observe and rate a child’s proficiency across the items (e.g., engages in cooperative play or recognizes shapes) and this helps us understand children’s “readiness” for school. There are other important factors that contribute to a child’s success in school, including “ready” schools and “ready” parents, and the socio-political and environmental factors in a child’s life.31

In 2019-2020, 36% of kindergarteners in Sonoma County entered kindergarten “ready to go.” White students were more likely to enter “ready to go” Latinx students (51% and 26%, respectively) (graph and figure, below). Children whose annual family income was $75,000 or more were over 2 times more likely to enter kindergarten Ready to Go compared to children whose annual family income was $34,999 or less (data not shown).

First 5 Focus Schools, 2018-19 Elementary schools where 50% or more students were eligible for the Free or Reduced Meal Program (FRMP), were English Language Learners (ELL), and/or foster youth are included in First 5 Sonoma County’s focus schools list. In 2018-19, 50 elementary schools in Sonoma County had 50% or more students (nearly 13,000 students) who met these criteria. These schools are located throughout Sonoma County. A complete table is in the Appendix.

31 Sonoma County School Readiness Report: https://www.c2csonomacounty.org/ready-resources

The following five schools had 95% or more students who are FRMP eligible and/or ELL: Kashia (100%, 15 students), Roseland (97%, 535 students), Sheppard (97%, 478 students), Roseland Creek (95%, 350 students), and McDowell (95%, 239 students).

Of the top 20 schools on the list, 12 are in the greater Santa Rosa area, three are in Sonoma, two are in West County, and there is one school each in Petaluma, Cotati/Rohnert Park, and Healdsburg. Of the top 20 schools on the list, five are in Santa Rosa Elementary School District, four are in Bellevue Union Elementary School District, three are in Roseland School District, and three are in Sonoma Valley Unified School District (Table below).

Summary of Findings Below is a summary of some the key demographic, early relational health and development, family resiliency and neighborhoods, and high-quality early childcare and education findings.

Demographics

• Approximately 4,700-5,000 babies will be born each year in Sonoma County through 2029 • Over half of babies are being born into 30 of the County’s 99 census tracts o Many of these census tracts are characterized by higher levels of family poverty, fewer neighborhood resources, and higher non-white populations than the County average.

Early Relational Health and Development

• Women whose births are paid for by Medi-Cal are more likely to experience challenges before and during pregnancy that impact the health and healthy development of their baby. o Almost half of babies born in southwest, southeast, and north Santa Rosa are births paid for by Medi-Cal; nearly 2 in 5 births in North County (Cloverdale, Geyserville, and Healdsburg) are paid for by Medi-Cal. o Some of the challenges women with Medi-Cal births are more likely to experience include: depression and intimate partner violence during pregnancy, and food insecurity. • Children living in poverty are at higher risk for Adverse Childhood Experiences (ACEs), in part due to structural determinants rather than family determinants. Social conditions are one of the mechanisms that influence ACEs, toxic stress, and their impact on developing children. Targeted interventions in communities with higher levels of family poverty can reduce ACEs and mitigate their effects on young children.

Family Resiliency and Neighborhoods

• Highest need, lowest resourced census tracts were located in Santa Rosa (Taylor Mountain, Wright, Bellevue, Kawana Springs, and Sheppard), Rohnert Park (Downtown Rohnert Park, Rohnert Park A Section, and Rohnert Park B/C/R Section), Sonoma Valley ( Fetters Springs/Agua Caliente West and Boyes Hot Springs/Fetters Springs/Agua Caliente East), West Cotati/Penngrove, and East Cloverdale. • Two early indicators of the economic impact of COVID-19 include the following: o An outsized impact on poor and Spanish-speaking families. Spanish-speaking parents with young children were more likely to lose all their household income compared to English-speaking parents as of mid-April 2020 o 18% (49,000 people) of the Sonoma County workforce filed initial unemployment claims in the first month of the shelter-in-place order. At a state level, and likely at a local level, younger people (25-34 years; people more likely to have families with young children), and people with lower levels of education were more likely to file initial unemployment claims.

High-quality Early Childcare and Education

• The supply of subsidized infant and preschool-age early childcare is inadequate to meet the demand in Sonoma County.

o There are regional differences in supply and demand, and COVID-19 will have impacts on both supply and demand.

Kindergarten readiness • In 2019-2020, 36% of kindergarteners in Sonoma County entered kindergarten “ready to go.” • Disparities in “readiness” correlated with race and income. Children whose annual family income was $75,000 or more were over 2 times more likely to enter kindergarten Ready to Go compared to children whose annual family income was $34,999 or less, and white students were twice as likely to be Ready to Go compared to Latino students.

Appendix

Births: 2006 - 2015

Locations Rate per 1,000 Women

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

California 71.9 72.2 70.0 67.3 64.7 63.5 63.5 62.2 63.1 61.7

Sonoma 64.4 62.7 62.9 62.7 59.3 56.5 56.3 54.1 54.7 53.9 County

Definition: Number of live births per 1,000 women ages 15-44 (i.e., General Fertility Rate). E.g., in 2015, there were 61.7 births per 1,000 California women ages 15-44.

Data Source: As cited on kidsdata.org, California Dept. of Public Health, Birth Statistical Master Files; California Dept. of Finance, Population Estimates by Race/Ethnicity with Age and Gender Detail 1990-2009; Population Reference Bureau, Population Estimates 2010-2015; CDC WONDER Online Database, Natality Public-Use Data (Aug. 2017).

Number of births in Sonoma County census tracts, 2018 # of Rank Census Tract births 1 Taylor Mountain 141 2 Wright 140 3 Bellevue 116 4 Bicentennial Park 115 5 Kawana Springs 103 6 Lucchesi/McDowell 96 7 West End 90 8 West Windsor 90 9 Coddingtown 84 10 Olivet Road 77 11 West Cotati/Penngrove 77 12 Sheppard 75 13 Railroad Square 73 14 Downtown Rohnert Park 72

Fetters Springs/Agua Caliente 15 West 70 16 Comstock 69 17 Roseland Creek 69 18 Spring Lake 68 19 Brush Creek 64 20 Central Windsor 63 21 Fulton 63 22 Rohnert Park SSU/J Section 63 23 Roseland 63 24 Montgomery Village 61 25 West Bennett Valley 61 26 Boyes Hot Springs West/El Verano 60 27 Laguna de Santa Rosa/Hall Road 59 28 McKinley 57 29 Middle Rincon South 54 Northern Junior College 30 Neighborhood 54 31 West Cloverdale 53 32 La Tercera 52 33 Rohnert Park M Section 52 34 Central Healdsburg 50 35 Rohnert Park A Section 50 36 Shiloh South 50 37 East Cotati/Rohnert Park L Section 49 38 Piner 48 39 Petaluma Airport/Arroyo Park 47 40 Rohnert Park F/H Section 47 41 Grant 46 42 Casa Grande 45 43 East Cloverdale 45 44 Miwok 43 45 Pioneer Park 43 46 Skyhawk 43 47 Windsor Southeast 42 48 North Sebastopol 40 49 North Healdsburg 39 50 Rohnert Park B/C/R Section 39 Boyes Hot Springs/Fetters 51 Springs/Agua Caliente East 38 52 Rohnert Park D/E/S Section 38 53 West Sebastopol/Graton 38 54 Larkfield-Wikiup 37 55 Old Quarry 37 56 Downtown Cotati 36 57 Burbank Gardens 35

Sonoma City North/West 58 Mayacamas Mountain 34 59 Central Rohnert Park 33 60 Rural Cemetery 33 61 Two Rock 33 62 Middle Rincon North 32 63 Hessel Community 31 64 Sunrise/Bond Parks 31 65 Meadow 30 66 Sonoma Mountain 30 67 Spring Hill 30 68 Fountain Grove 29 69 Russian River Valley 29 70 Southeast Sebastopol 29 71 Downtown Santa Rosa 28 Southern Junior College 72 Neighborhood 28 73 West Junior College 28 74 Northeast Windsor 27 75 Sonoma City South/Vineburg 27 76 Central Bennett Valley 26 77 Cherry Valley 26 78 Kenwood/Glen Ellen 26 79 Old Healdsburg 26 80 Central East Windsor 25 81 Schaefer 23 82 Forestville 22 83 Guerneville/Rio Nido 22 84 Occidental/Bodega 21 85 Carneros Sonoma Area 20 86 East Bennett Valley 20 87 Gold Ridge 19 88 Monte Rio 19 89 Alexander Valley 18 90 Cinnabar/West Rural Petaluma 18 91 Windsor East 18 92 Southwest Sebastopol 16 93 Downtown Sonoma 15 94 Dry Creek 12 95 Jenner/Cazadero 12 Arnold Drive/East Sonoma 96 Mountain 9 97 Annadel/South Oakmont 6 98 North Oakmont/Hood Mountain 6 99 Sea Ranch/Timber Cove <5

Number of Births (2016), Mean Strong Start Score (2016), Percentage of Families in Poverty (2017), and Percentage Non-white Population (2017), Overall Rank and Indicator Rank, by Census Tract Overall Ranking 2016 Strong Start 2017 % families in poverty 2017 % non-white (2016 data) Index (<100% FPL) population Ranking - Mean # of % of

Portrait of Sonoma Strong Ranking - % families families County Census Tract # of Overall Start Strong below in in % non- Ranking - % Name Births Rank Score Start poverty poverty poverty white non-white

1 Taylor Mountain 144 12 8.7 4 14% 280 4 66% 4

2 Railroad Square 97 12 9.0 4 13% 178 4 50% 4

3 Comstock 82 12 8.6 4 18% 215 4 69% 4

4 Roseland Creek 76 12 9.0 4 15% 146 4 73% 4 Fetters Springs/Agua 5 Caliente West 71 12 8.8 4 15% 200 4 76% 4

6 Roseland 67 12 8.7 4 31% 241 4 74% 4

7 Wright 152 11 9.1 3 11% 309 4 65% 4

8 Bellevue 136 11 8.7 4 8% 125 3 69% 4

9 Kawana Springs 123 11 9.3 3 11% 189 4 55% 4

10 Sheppard 100 11 8.4 4 7% 86 3 78% 4

11 Coddingtown 92 11 9.1 3 17% 238 4 54% 4

12 West End 75 11 8.8 4 8% 95 3 67% 4

13 Downtown Rohnert Park 75 11 9.0 4 8% 108 3 50% 4

14 Rohnert Park A Section 56 11 8.7 4 8% 81 3 52% 4

15 Downtown Santa Rosa 33 11 8.2 4 18% 58 4 36% 3

16 Bicentennial Park 110 10 8.9 4 6% 83 2 60% 4

17 West Cotati/Penngrove 71 10 8.9 4 8% 129 3 39% 3

18 East Cloverdale 47 10 9.2 3 9% 73 3 53% 4 Boyes Hot Springs/Fetters 19 Springs/Agua Caliente East 46 10 9.2 3 11% 110 4 40% 3

20 Miwok 45 10 8.9 4 6% 73 3 39% 3

21 Rohnert Park B/C/R Section 43 10 9.3 3 13% 128 4 35% 3

22 Burbank Gardens 32 10 9.4 3 9% 55 3 42% 4

Mean # of Ranking - Portrait of Sonoma Strong Ranking - families % of Ranking - County Census Tract # of Overall Start Strong % below in families in % non- % non- Name Births Rank Score Start poverty poverty poverty white white 23 Guerneville/Rio Nido 31 10 8.9 4 16% 125 4 22% 2 Boyes Hot Springs 24 West/El Verano 67 9 8.4 4 3% 51 2 37% 3 25 McKinley 65 9 8.9 4 4% 45 2 40% 3 26 Schaefer 64 9 9.6 2 7% 101 3 40% 4 27 Grant 46 9 9.5 2 11% 103 4 37% 3 East Cotati/Rohnert Park 28 L Section 46 9 9.0 4 7% 90 3 23% 2 29 Sunrise/Bond Parks 46 9 9.3 3 6% 69 3 37% 3 Northern Junior College 30 Neighborhood 44 9 9.7 2 10% 77 4 36% 3 31 Spring Hill 41 9 9.0 4 9% 113 3 27% 2 32 Downtown Cotati 40 9 9.2 3 7% 50 3 34% 3 33 Middle Rincon North 23 9 9.3 3 9% 68 3 36% 3 34 Dry Creek 19 9 9.3 3 11% 86 4 26% 2 35 West Windsor 117 8 9.7 2 4% 94 2 47% 4 Laguna de Santa 36 Rosa/Hall Road 76 8 9.7 2 9% 163 3 39% 3 37 Brush Creek 68 8 9.8 1 12% 167 4 34% 3 38 Olivet Road 61 8 9.7 2 5% 100 2 44% 4 39 Casa Grande 59 8 9.2 3 6% 59 2 37% 3 40 Central Healdsburg 59 8 9.4 2 3% 35 2 49% 4 41 Shiloh South 56 8 9.7 2 6% 85 3 38% 3 42 Central Windsor 51 8 9.2 3 2% 20 1 49% 4 43 La Tercera 48 8 9.3 3 7% 89 3 31% 2 44 Windsor Southeast 46 8 9.4 3 2% 24 1 41% 4 45 Central Rohnert Park 41 8 9.2 3 4% 32 2 32% 3 46 Larkfield-Wikiup 38 8 9.5 2 8% 98 3 34% 3

Mean # of Ranking - Portrait of Sonoma Strong Ranking - families % of County Census Tract # of Overall Start Strong % below in families in % non- Ranking - % Name Births Rank Score Start poverty poverty poverty white non-white Southern Junior College 47 Neighborhood 31 8 9.7 2 18% 116 4 25% 2 48 Monte Rio 29 8 9.3 3 17% 114 4 18% 1 49 Alexander Valley 27 8 9.8 1 9% 87 4 38% 3 50 Spring Lake 76 7 9.3 3 2% 36 1 35% 3 51 Lucchesi/McDowell 71 7 9.2 3 4% 67 2 32% 2 52 Montgomery Village 64 7 10.0 1 13% 152 4 28% 2 Rohnert Park D/E/S 53 Section 41 7 9.6 2 9% 94 3 31% 2 54 Middle Rincon South 41 7 9.7 2 6% 66 3 27% 2 55 Pioneer Park 40 7 9.4 2 2% 26 1 49% 4 Sonoma City 56 South/Vineburg 37 7 9.4 3 8% 95 3 20% 1 57 Meadow 36 7 10.1 1 12% 129 4 28% 2 58 Southeast Sebastopol 35 7 9.1 3 3% 33 2 22% 2 59 West Sebastopol/Graton 29 7 9.1 4 5% 71 2 20% 1 60 West Bennett Valley 55 6 9.7 2 5% 86 2 23% 2 61 Piner 50 6 9.8 1 4% 49 2 40% 3 Rohnert Park F/H 62 Section 48 6 9.9 1 4% 58 2 34% 3 63 North Sebastopol 40 6 10.0 1 10% 159 4 15% 1 64 Two Rock 38 6 9.0 4 2% 30 1 21% 1 65 Northeast Windsor 38 6 9.7 2 0% 0 1 35% 3 66 Central East Windsor 34 6 9.7 2 4% 34 2 32% 2 67 Cherry Valley 32 6 9.6 2 6% 55 3 14% 1 Sonoma City North/West 68 Mayacamas Mountain 32 6 9.6 2 4% 46 2 23% 2 Cinnabar/West Rural 69 Petaluma 31 6 9.2 3 3% 33 2 20% 1 70 Hessel Community 27 6 8.9 4 2% 32 1 15% 1 71 Jenner/Cazadero 23 6 9.3 3 4% 20 2 19% 1 72 Downtown Sonoma 21 6 10.0 1 10% 92 4 17% 1

Mean # of Ranking - Portrait of Sonoma Strong Ranking - % families % of Ranking - County Census Tract # of Overal Start Strong below in families in % non- % non- Name Births Rank Score Start poverty poverty poverty white white Arnold Drive/East Sonoma 73 Mountain 14 6 8.7 4 0% 0 1 14% 1 74 Rohnert Park M Section 73 5 9.4 2 2% 30 1 27% 2 75 Fulton 61 5 10.2 1 2% 34 1 34% 3 76 West Cloverdale 60 5 9.8 1 5% 77 2 32% 2 Rohnert Park SSU/J 77 Section 48 5 9.7 1 3% 44 2 26% 2 78 Kenwood/Glen Ellen 34 5 9.2 3 3% 42 1 16% 1 79 Gold Ridge 30 5 9.9 1 8% 95 3 19% 1 80 Old Healdsburg 30 5 9.6 2 2% 27 1 26% 2 81 Forestville 24 5 9.6 2 3% 28 2 21% 1 82 West Junior College 24 5 9.7 2 2% 10 1 31% 2 83 Occidental/Bodega 23 5 9.5 2 6% 50 2 9% 1 84 Fountain Grove 59 4 10.3 1 3% 83 1 23% 2 85 Sonoma Mountain 53 4 9.8 1 3% 39 1 26% 2 86 Old Quarry 42 4 9.9 1 2% 24 1 22% 2 87 Central Bennett Valley 41 4 9.6 2 2% 17 1 22% 1 88 North Healdsburg 36 4 10.1 1 3% 33 1 30% 2 89 Rural Cemetery 29 4 10.6 1 4% 39 2 21% 1 90 Southwest Sebastopol 27 4 10.3 1 5% 55 2 12% 1 91 Skyhawk 50 3 10.0 1 2% 46 1 18% 1 Petaluma Airport/Arroyo 92 Park 34 3 10.0 1 1% 15 1 20% 1 93 Russian River Valley 30 3 9.7 1 3% 28 1 14% 1 94 Windsor East 19 3 10.2 1 0% 0 1 21% 1 95 East Bennett Valley 17 3 10.3 1 0% 0 1 12% 1 96 Annadel/South Oakmont 13 3 10.1 1 2% 16 1 5% 1 Data sources: 2016 California Strong Start Index; 2017 5-year American Community Survey (ACS) estimates families in poverty; 2017 5-year ACS estimates % population non-white. Note: census tracts where more than 100 babies were born are highlighted in yellow.

Number and percent of families with children under 18 years old living <200% federal poverty level in the past 12 months, by Sonoma County census tract, 2018 5-year estimates % of # of # of families families w/ families w/ w/ children children children under 18 under 18 under 18 y.o. <200% y.o. <200% Line # PoSC name y.o. FPL FPL 1 Comstock 1,522 1,102 72% 2 East Cloverdale 979 679 69% 3 Downtown Santa Rosa 241 165 68% 4 Taylor Mountain 2,742 1,763 64% 5 Roseland 1,125 717 64% 6 Northern Junior College Neighborhood 627 391 62% 7 Wright 2,971 1,688 57% 8 Burbank Gardens 575 326 57% 9 Olivet Road 1,809 987 55% 10 Bellevue 2,432 1,299 53% 11 Bicentennial Park 1,595 852 53% 12 Monte Rio 452 237 52% 13 Coddingtown 1,319 670 51% 14 McKinley 1,100 566 51% 15 Gold Ridge 741 372 50% 16 West Cotati/Penngrove 1,503 731 49% 17 Fetters Springs/Agua Caliente West 1,640 750 46% 18 Montgomery Village 741 343 46% 19 West End 1,731 773 45% 20 Schaefer 1,171 528 45% 21 Central Rohnert Park 811 369 45% 22 Windsor Southeast 992 419 42% 23 Downtown Rohnert Park 1,480 606 41%

24 Alexander Valley 604 246 41% 25 Southern Junior College Neighborhood 430 178 41% 26 Meadow 933 370 40% 27 Downtown Cotati 633 253 40% 28 Sheppard 1,405 539 38% 29 Cinnabar/West Rural Petaluma 607 233 38% 30 Roseland Creek 1,149 429 37% 31 West Bennett Valley 1,117 412 37% 32 North Sebastopol 982 365 37% 33 Central Healdsburg 940 343 36% 34 Downtown Sonoma 659 238 36% Boyes Hot Springs/Fetters Springs/Agua 35 Caliente East 502 179 36% 36 Pioneer Park 1,143 401 35% 37 Shiloh South 1,219 399 33% 38 Old Healdsburg 796 263 33% 39 Railroad Square 1,240 391 32% 40 Kawana Springs 1,696 521 31% 41 Rohnert Park A Section 1,161 358 31% 42 Boyes Hot Springs West/El Verano 1,364 403 30% 43 Laguna de Santa Rosa/Hall Road 1,335 401 30% 44 Central Windsor 788 231 29% 45 West Cloverdale 1,145 316 28% 46 Sunrise/Bond Parks 1,056 283 27% 47 Larkfield-Wikiup 879 232 26% 48 Middle Rincon North 751 192 26% 49 Central East Windsor 691 178 26% 50 Rohnert Park B/C/R Section 728 179 25% 51 Brush Creek 1,387 338 24% 52 Two Rock 1,097 260 24% 53 Spring Hill 949 231 24%

54 Forestville 401 97 24% 55 Jenner/Cazadero 279 67 24% 56 Rohnert Park F/H Section 1,193 269 23% 57 Miwok 1,101 249 23% 58 Rohnert Park D/E/S Section 1,009 229 23% 59 East Cotati/Rohnert Park L Section 713 167 23% 60 Guerneville/Rio Nido 464 108 23% 61 Dry Creek 317 73 23% 62 West Windsor 2,441 516 21% 63 Cherry Valley 636 134 21% 64 La Tercera 860 168 20% 65 Middle Rincon South 994 192 19% 66 Grant 867 166 19% 67 Southeast Sebastopol 626 116 19% 68 Southwest Sebastopol 592 115 19% 69 Fulton 1,093 197 18% 70 Petaluma Airport/Arroyo Park 850 151 18% 71 Spring Lake 1,241 202 16% 72 Rohnert Park SSU/J Section 959 158 16% 73 Piner 851 135 16% 74 Sonoma City South/Vineburg 715 113 16% 75 Old Quarry 1,161 177 15% 76 West Junior College 332 50 15% 77 Kenwood/Glen Ellen 662 92 14% 78 Russian River Valley 527 75 14% 79 West Sebastopol/Graton 806 108 13% 80 Occidental/Bodega 247 31 13% 81 North Healdsburg 646 75 12% 82 Hessel Community 462 54 12% 83 Casa Grande 907 94 10% 84 Lucchesi/McDowell 1,365 124 9%

85 Skyhawk 1,716 141 8% 86 Rural Cemetery 693 54 8% 87 Sonoma Mountain 1,252 93 7% 88 Rohnert Park M Section 998 68 7% 89 Annadel/South Oakmont 121 8 7% 90 Fountain Grove 1,435 83 6% Sonoma City North/West Mayacamas 91 Mountain 679 32 5% 92 Arnold Drive/East Sonoma Mountain 322 9 3% 93 Central Bennett Valley 732 11 2% 94 Northeast Windsor 854 10 1% 95 Carneros Sonoma Area 343 4 1% 96 Windsor East 763 0 0% 97 East Bennett Valley 547 0 0%

U.S. Census Bureau, ACS 2018 5-year estimates, Table B05010; margin of error is not reported - interpret estimates with caution; Oakmont and Sea Ranch/Timber Cove were excluded due to small numbers.

Abbreviated figure.

Number and percentage of English Language Learners (ELL) and FRMP Eligible Students, by District and School, First 5 Sonoma County Focus Schools List, 2018-2019 School District School Name Total # ELL + % of total Region Rank Student FRMP enrollment Enrollment Eligible 1 Kashia Elementary *Kashia Elementary 15 15 100 West County 2 Roseland Roseland Elementary 549 535 97 Santa Rosa 3 Roseland Sheppard Elementary 493 478 97 Santa Rosa 4 Roseland Roseland Creek Elementary 367 350 95 Santa Rosa 5 Petaluma City Elementary McDowell Elementary 251 239 95 Petaluma 6 Santa Rosa Elementary Brook Hill Elementary 388 364 94 Santa Rosa 7 Bellevue Union Meadow View Elementary 93 Santa Rosa Elementary 414 384 8 Santa Rosa Elementary James Monroe Elementary 402 372 93 Santa Rosa 9 Santa Rosa Elementary Abraham Lincoln Elementary 284 262 92 Santa Rosa 10 Bellevue Union Bellevue Elementary 406 371 91 Santa Rosa Elementary 11 Bellevue Union Taylor Mountain Elementary 91 Santa Rosa Elementary 439 401 12 Sonoma Valley Unified Sassarini Elementary 320 291 91 Sonoma 13 Santa Rosa Elementary Luther Burbank Elementary 315 286 91 Santa Rosa 14 Cotati-Rohnert Park John Reed Primary 90 Cotati/Rohnert Unified 425 381 Park 15 Healdsburg Unified Healdsburg Elementary 262 231 88 Healdsburg 16 Bellevue Union Kawana Springs Elementary 87 Santa Rosa Elementary 354 308 17 Sonoma Valley Unified Dunbar Elementary 187 162 87 Sonoma 18 Santa Rosa Elementary Helen M. Lehman Elementary 508 439 86 Santa Rosa 19 Sonoma Valley Unified El Verano Elementary 363 312 86 Sonoma 20 Fort Ross Elementary *Fort Ross Elementary 21 18 86 West County 21 Horicon Elementary Horicon Elementary 68 58 85 West County 22 Santa Rosa Elementary Steele Lane Elementary 413 351 85 Santa Rosa 23 Old Adobe Union Miwok Valley Language Academy 82 Petaluma Charter 325 268 24 Wright Elementary Robert L. Stevens Elementary 545 439 81 Santa Rosa

25 Cotati-Rohnert Park Thomas Page Academy 78 Cotati/Rohnert Unified 385 301 Park 26 Guerneville Elementary Guerneville Elementary 242 188 78 West County 27 Wright Elementary Wright Charter 456 353 77 Santa Rosa 28 Cinnabar Elementary Cinnabar Charter 240 183 76 Petaluma 29 Santa Rosa Elementary Albert F. Beilla Elementary 330 251 76 Santa Rosa 30 Santa Rosa Elementary Kid Street Learning Center 72 Santa Rosa Charter 116 84 31 Wright Elementary J.X. Wilson Elementary 473 341 72 Santa Rosa 32 Cloverdale Unified Jefferson Elementary 536 382 71 Cloverdale 33 Santa Rosa Elementary Cesar Chavez Language 70 Santa Rosa Academy 368 258 34 Monte Rio Union Monte Rio Elementary 68 West County Elementary 84 57 35 Sonoma Valley Unified Flowery Elementary 339 226 67 Sonoma 36 Geyserville Unified Geyserville Elementary 107 70 65 West County 37 Piner-Olivet Union Morrice Shaefer Charter 65 Santa Rosa Elementary 345 224 38 Old Adobe Union Loma Vista Immersion Academy 400 236 59 Petaluma 39 Cotati-Rohnert Park *University Elementary at La 55 Cotati/Rohnert Unified Fiesta 204 113 Park 40 Windsor Unified Cali Calmecac Language 55 Windsor Academy 1,138 625 41 Rincon Valley Union Whited Elementary Charter 55 Santa Rosa Elementary 406 222 42 Sebastopol Union Park Side Elementary 54 Sebastopol Elementary 261 140 43 Mark West Union Mark West Elementary 53 Santa Rosa Elementary 438 234 44 Rincon Valley Union Binkley Elementary Charter 53 Santa Rosa Elementary 360 191 45 Two Rock Union *Two Rock Elementary 154 81 53 Petaluma 46 Piner-Olivet Union Jack London Elementary 51 Santa Rosa Elementary 279 143 47 Piner-Olivet Union Olivet Elementary Charter 50 Santa Rosa Elementary 319 161 48 Rincon Valley Union Village Elementary Charter 50 Santa Rosa Elementary 364 182

49 Petaluma City Elementary **Valley Vista Elementary 280 139 50 Petaluma 50 Rincon Valley Union Santa Rosa Elementary **Spring Creek Matanzas Charter 533 269 50 Students in First 5 Focus 17,271 12,969 75 Schools Data note: unduplicated count of ELL, FRPM, and foster youth. FRPM =Free or Reduced Price Meals (FRPM). *new to First 5 Focus Schools in FY16-17; **new to First 5 Focus Schools in FY18-19