CENTER ON URBAN POVERTY AND SOCIAL CHANGE Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report June 2005 Submitted by Mandel School of Applied Social Sciences Case Western Reserve University with Chapin Hall Center for Children University of Chicago and with consultants from Frank Porter Graham Child Development Institute University of North Carolina at Chapel Hill Principal Investigator: Claudia Coulton, Ph.D. Contact Information: Rob Fischer, Ph.D. Center on Urban Poverty and Social Change Case Western Reserve University 10900 Euclid Avenue Cleveland, Ohio 44106-7164 Phone: 216/368-3801 Fax: 216/368-2295 [email protected] http://povertycenter.case.edu Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report Recommended Citation: Center on Urban Poverty and Social Change. (2005). Cuyahoga County Early Childhood Initiative evaluation: Phase II final report. Cleveland, OH: Case Western Reserve University, Mandel School of Applied Social Sciences. The Report and Executive Summary are available in .PDF format at http://povertycenter.case.edu/ or by contacting: The Center on Urban Poverty and Social Change Mandel School of Applied Social Sciences Case Western Reserve University 10900 Euclid Avenue Cleveland, OH 44106-7164 (216) 368-3801 voice // (216) 368-2295 fax Center on Urban Poverty and Social Change ♦ Mandel School of Applied Social Sciences ♦ Case i Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report Acknowledgements This final report on the first 5 years of the Cuyahoga County Early Childhood Initiative could not have been completed without the cooperation and commitment of numerous individuals and organizations. The funding for this research was provided through the ECI Partnership Committee. The Committee includes the Cuyahoga County Commissioners, and representatives from the State of Ohio, as well as from supporting foundations, corporations, and other private sector partners, all having a shared vision about ensuring the well-being of young children and their families. The authors would like to recognize in particular: Michelle Katona, Director, Cuyahoga County Early Childhood Initiative (now Invest in Children), worked closely with the research team from fall 2003 through the evaluation effort and provided substantial input to this report. In addition, Molly Irwin, the former interim Director of ECI provided key input over the last 2 years of the study. Rick Werner, Deputy County Administrator for Health and Human Services, Cuyahoga County, provided invaluable leadership and support for the evaluation in his role as coordinator of the agencies implementing the Early Childhood Initiative. Goldie Alvis, Senior Program Officer for Social Services, and Jay Talbot, Senior Program Officer for Civic Affairs and Manager of Special Projects, The Cleveland Foundation, actively participated in the conceptualization of the evaluation and in the interpretation and communication of its findings. The directors of the program areas under study, Joseph Gauntner, Director of Employment and Family Services (EFS), Billie Osborne-Fears, Executive Director of Starting Point and Melissa Manos, Director of Help Me Grow Collaborative of Cuyahoga County, shared in and facilitated the work of the evaluation team and helped in problem solving when challenges arose. They and their key staff contributed greatly to ensuring the accuracy and usefulness of this report. We would also like to acknowledge the contribution of the following agency staff: Robert Staib, formerly of EFS; Bill Goodrich, Constance Walker, and Beverly Williams of Starting Point; and Kate Bryant and Sue Pelleg of Help Me Grow. Three individuals served as advisors to the ECI research team and provided useful insights and counsel throughout the effort: Dr. Dennis Drotar, Department of Pediatrics, Rainbow Babies and Children's Hospital; Dr. Jill Korbin, Department of Anthropology, Case Western Reserve University; and, Dr. Philip Safford, Senior Consultant, Schubert Center for Child Development, Case Western Reserve University. In addition, Dr. Deanna Gomby, a consultant to The Cleveland Foundation, provided invaluable input on the evaluation analyses and findings. Finally, the research team would like to recognize the input of the families served by the ECI and the direct-service providers who participated in this research effort. Without their active participation, the evaluation would provide a far less comprehensive assessment of the accomplishments of the Initiative. The Authors Center on Urban Poverty and Social Change ♦ Mandel School of Applied Social Sciences ♦ Case ii Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report Table of Contents Page Acknowledgements ii List of Tables iv List of Figures xi List of Appendices xiii List of Abbreviations and Acronyms xv Chapter Contributors xvii Executive Summary ES-1 Team 1. Developing and Sustaining a Comprehensive Community Initiative on Early 1-1 Childhood Rob Fischer & Claudia Coulton 2. Early Childhood Social and Health Indicators in Cuyahoga County 2-1 Claudia Coulton, Engel Polousky, Nina Lalich, & Ini Shin 3. The Scope and Reach of the ECI: Monitoring the Coverage and Connections 3-1 of Initiative Programs Rob Fischer, Nina Lalich, Maruza Andrade, & Claudia Coulton 4. Welcome Home and Early Start: An Assessment of Program Quality and 4-1 Outcomes Deborah Daro, Eboni Howard, Jennifer Tobin, & Allen Harden 5. Increasing Capacity and Enhancing Quality in Cuyahoga County’s Family 5-1 Child Care System Sue Pearlmutter, Liane Grayson, & Meg Fernando 6. Improving Special Needs Child Care by Supporting Providers and Families 6-1 Gerald Mahoney, Kathleen Quinn-Leering, & Meg Fernando 7. Medicaid Enrollment and Utilization in Cuyahoga County: Evaluating the 7-1 Early Childhood Initiative Amid Other Health Systems Changes Siran Koroukian, Engel Polousky, Rob Fischer, & Claudia Coulton Full Research Team Listing Center on Urban Poverty and Social Change ♦ Mandel School of Applied Social Sciences ♦ Case iii Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report List of Tables Chapter Title Page Chapter 1 Table 1.1 Initiative Budgets for Phases I & II 1-7 Table 1.2 ECI Proposed Budgets:2005-2007 by Goal 1-8 Chapter 2 Table 2.1 Population Estimates of Children Under Six, 2-5 Cuyahoga County, 1990-2003 Table 2.2 Trends in Births and Birth Characteristics, 2-7 Cuyahoga County, 1990-2002 Table 2.3 Percent of Children Under Five in Poverty, Cuyahoga 2-8 County, Ohio and U.S. Table 2.4 Children Under Six Receiving Cash Welfare: 2-9 Cuyahoga County, 1992-2003 Table 2.5 Maltreatment of Children Under Six: Cuyahoga County, 2-11 1992-2003 Table 2.6 Probability of Experiencing a Substantiated or Indicated 2-13 Maltreatment Incident by Birth Cohort and Age at First Report (Hazard Rate) Table 2.7 Percent of Children Under Six Experiencing a Second 2-16 Incident of Child Maltreatment Within One Year of the First Incident by Birth Cohort and Age at First Incident: Cuyahoga County, 1992-2002 Table 2.8 Deaths of Children Under Six and Death Rate per 1000, 2-19 Cuyahoga County, 1990-2002 Table 2.9 Number of Children Enrolled in Regulated Child Care by 2-20 Age Group and Setting, Cuyahoga County, 1996, 1998, 2000-2004 Table 2.10 Number of Children in EI by Birth Cohort and Age of First 2-23 EI Visit Chapter 3 Table 3.1 Number of Children Served by ECI, by Birth Cohort and 3-6 Age at First Encounter for Children Born (July 1993 - December 2003) Chapter 4 Table 4.1 Eligible Sample for Phase II Selection 4-8 Center on Urban Poverty and Social Change ♦ Mandel School of Applied Social Sciences ♦ Case iv Cuyahoga County Early Childhood Initiative Evaluation: Phase II Final Report Chapter 4 (continued) Table 4.2 Demographic Characteristics of Study Sample at Time of 4-15 Study Enrollment Table 4.3 Baseline Scores of Performance Measures 4-17 Table 4.4 Initial Concerns and Belief that Early Start or a Community 4-20 Service Could Help Table 4.5 Service Experiences of Eight Cohorts of Children Referred 4-24 to Early Start between July 1999 and March 2003 Table 4.6 Service Experiences of Children Referred to Early Start 4-26 Between July 1999 and March 2002 by Early Start Service Agency Table 4.7 Characteristics of Home Visits, IFSPs, and Family 4-30 Concerns from Early Start Providers at Different Follow-up Periods for All Early Start Sample Participants Table 4.8 Initial and Final Helping Relationship Inventory Mean 4-32 Scores Between Mothers and Home Visitors Table 4.9 Logistic Regression Analysis of Demographic Characteristics 4-34 Parental Baseline Measures, and Early Start Referral Source on Ever Receiving an Early Start Home Visit Table 4.10 Predictive Relationships of Total Number of Home Visits 4-37 (HV) on Demographic Characteristics, Parental Baseline Measures, Early Start Referral Source, and Helping Relationship Inventory (HELP) Table 4.11 Change over Time in Personal Functioning Among Welcome 4-40 Home Only and Early Start Referral Groups Table 4.12 Gain Score Analysis Between Welcome Home-Early Start 4-42 and Welcome Home-Only Groups Within One Standard Deviation of the CAP Mean and with CAP Scores Above One Standard Deviation of the CAP Mean for Both Groups Table 4.13 Gain Score Analysis Between Early Start Referrals Who 4-44 Received or Did Not Receive at Least One Home Visit Table 4.14 Full OLS Regression Model of Changes in Early Start 4-45 Participant