Goal 4: Improve and integrate health and early care and education services for children 0-5 so they enter school ready to learn

Outcome 4A

Children Have Access To Health, Mental Health And Developmental Services

This year, 1,404 families at highest risk of poor outcomes received home visits.  These families maintained their status or excelled on several measures of child health and well-being. 


In addition, 4,617 children were screened for developmental concerns through a variety of programs, of whom 1,254 were identified early for concerns.  Importantly, most of these children were connected to additional supports.

[The Mental Health Consultant] worked closely with...[the] mother [of B]...[a] child who was referred to Regional Center services. The MHC helped...[the] mother cope with the news that her child had a developmental delay. B's mother had no one else to talk to and it was a great support to her to have [the assistance of the] MHC...during this challenging time.
-MHC contractor report

Indicator 1: Developmental Screening [more]

Proportion of children served who are screened for developmental/ social/ emotional concerns by program

How do we compare?

There is significant under-detection of developmental delays in early childhood. While the prevalence of developmental delays is at least 10 percent, early intervention programs that address these concerns serve only 2.3 percent of children under age 3. Use of validated developmental screening tools is supported by American Academy of Pediatrics guidelines, but these instruments are neither widely nor systematically used in pediatric practice. 

2010-2011 Results

F5AC provides training and support to home visitors and other providers to increase the number of children screened for developmental and social/emotional concerns.  The number of children screened continues to increase.  More than 4,700 children were screened this year compared to 3,834 last year.

  • 422 children in ECE classrooms were screened with both the ASQ and ASQ-SE
  • 2,819 children in participating private pediatric and community clinics were screened with the ASQ.  80% of the screens were conducted before the child’s 2nd birthday.
  • Ten community agencies receiving F5AC grants screened 382 children
  • Three agencies providing mental health consultation to early care and education sites serving 625 (duplicated) children conducted 73 screenings (12% of children)
  • 994 children in home visiting programs were screened for developmental concern

Indicator 2: Referrals for Developmental / Social-Emotional Concerns [more]

Proportion of children receiving F5AC services screened positive for developmental/social-emotional concerns who are referred for further assessment or treatment services, by type of referral


How so we compare?

A national study of pediatric screening and referral practices reported pediatricians referring only 61% of children with failed screens.

2010-2011 Results
  • 313 or 35% of children receiving home visits were identified with concerns; 229 had concerns in more than one domain
  • 104 or 25% of children in ECE classroom scored of concern in at least one domain, 48 had more than one concern
  • 637 or 23% of children screened at pediatric sites showed concerns in at least one domain; 43% of the children needed monitoring in at least one domain
  • 174 or 46% of children screened by community grantees scored of concern in at least one domain.  174 (100%) were referred for further assessment or treatment services.
  • 26 children at Summer Pre-K camps were screened and identified with concerns; 11 referrals were made
  • 43 or 59% of children screened at ECE sites receiving mental health consultation scored of concern; all were referred (e.g., to the Regional Center of the East Bay, the school district, to an occupational therapist, for a speech and language assessment, for mental health therapy, to the Family Justice Center for domestic violence services or to in-house mental health services including playgroups)


Indicator 3: Developmental Supports Received [more]

Proportion of children receiving F5AC services referred for assessment / treatment services who received referred services (or appropriate follow-up)

2010-2011 Results
  • 124 of 174 referrals made by community grant recipients resulted in the children receiving service

  • 6 of 11 referrals made for children attending Summer Pre-K camps led to direct special services in Kindergarten  

"One little boy surely benefited from [the Summer Pre-K camp]... He was evaluated through First 5 and support is on the way. He will receive help much earlier than he would have, had he not been in the First 5 Pre-K program.” – School District midterm report

Indicator 4: Children Have Health Insurance [more]

Proportion of children receiving F5AC services who have health insurance

How do we compare?

In Alameda County, 96% of children ages 0-17 have health insurance.

2010-2011 Results

97% Intensive Family Support (n=1,392)

97% Special Start (n=639)

97% Teen (n=483)

99% Your Family Counts (n=270) 

Indicator 5: Children are Immunized [more]

Proportion of children receiving F5AC services who are up-to-date on immunizations


How do we compare?

92% of Kindergarteners in California, and 91% of Alameda County Kindergartners have all of their required immunizations at the time of kindergarten entry.

2010-2011 Results

98% Intensive Family Support (n=1,050)

98% Special Start (n=523)

98% Teen (n=357)

97% Your Family Counts (n=154)

Indicator 6: Children Have Identified Primary Pediatric Provider [more]

Proportion of children receiving F5AC services with an identified primary pediatric provider

How do we compare?

Nationally, 93% of children 17 yrs and younger have a specific source of ongoing care

HP 2020 target: 100%

2010-2011 Results

This year's strong results are consistent with those from past years.


99% Intensive Family Support (n=1,1322)

96% Special Start (n=640)

99% Teen (n=462)

98% Your Family Counts (n=243) 


Indicator 7: Children Have Appropriate Well Child Visits [more]

Proportion of children receiving F5AC services with appropriate well child visits per age

2010-2011 Results

This year's results are similar to results from past years.


98% Intensive Family Support (n=1,050)

98% Special Start (n=533)

99% Teen (n=361)

96% Your Family Counts (n=156)


Indicator 8: Annual Dental Exam [more]

Proportion of children one year or older who had an annual dental exam

How do we compare?

In Alameda County, only 20.5% of children 2 to 11 years old had a dental visit in the last 12 months (CHIS)

2010-2011 Results

49% Intensive Family Support (n=618)

54% Special Start (n=346)

45% Teen (n=196)

33% Your Family Counts (n=76)  

Indicator 9: Asthma ER Visits and Hospitalizations [more]

Proportion of children receiving F5AC services with ER visits or hospitalizations for asthma

How do we compare?

HP 2020 hospitalization and ER visit targets for children under five: 18.1 per 10,000 and 95.5 per 10,000. The annual average hospital and ER visits between 2005-2007 in Alameda County was 529/100,000 hospitalizations, 1,378/100,000 ER visits

2010-2011 Results

Managing environmental triggers and timely treatment of preventable illnesses such as asthma can reduce or eliminate the need for hospital visits. Annually since 2007, only 0%-3% children receiving home visiting services went to the emergency department or were hospitalized for complications from asthma.


2.7% Intensive Family Support (n=1,404)

3% Special Start (n=640)

0% Teen (n=494)

0% Your Family Counts (n=270)


Indicator 10: Reported Intentional Injuries [more]

Proportion of children receiving F5AC services with reported intentional injuries

2010-2011 Results

Unintentional injury was the leading cause of death among children one to 14 years of age, accounting for 27.7% of all deaths.  Injuries observed by home visitors remain very low.


0.3% Intensive Family Support (n=1,404)

0.5% Special Start (n=640)

0% Teen (n=494)

0% Your Family Counts (n=270)

Indicator 11: Reported Unintentional Injuries [more]

Proportion of children receiving F5AC services with reported unintentional injuries

2010-2011 Results


2.0% Intensive Family Support (n=1,404)

3.1% Special Start (n=640)

1.1% Teen (n=494)

0.5% Your Family Counts (n=270)

Indicator 12: Breastfeeding Duration [more]

Proportion of mothers who breastfed their babies 6 months or longer

How do we compare?

HP 2020 target for mothers who breastfeed:                  

  • Early Post Partum - 81.9%
  • At 6 mos. - 60.6%
  • At 1 year - 34.1% 

In Alameda County,14.6% exclusively breastfeed at 6 months of age.


2010-2011 Results

The percentage of Special Start and Teen mothers who breastfed 6 months or longer has increased from 33-37% over the past 2 years to 41-43% this year.








Up to 1 month





Up to 6 months





Up to 1 year





> 1 year





Total (N)






% who breastfed 6 mos or longer





Indicator 13: Exposure to 2nd Hand Smoke [more]

Proportion of children receiving F5AC services served exposed to secondhand smoke

How do we compare?

Nationally, 27 percent of children aged 6 years and under lived in a household where someone smoked inside the house at least 4 days per week in 1994.

In Alameda County, 8.7% pregnant women smoked

2010-2011 Results

Since 2007, children at greatest risk for poor outcomes (served through F5AC home visiting programs) were exposed to secondhand smoke at a rate of 2-17%.  This year, secondhand smoke exposure decreased most significantly among teen parents.


7% Intensive Family Support (n=1,058)

9% Special Start (n=534)

4% Teen (n=359)

7% Your Family Counts (n=165)


Funding from F5AC helped to support to the efforts of a children's hospital to screen every child 0-5 years who attends their primary care clinic for exposure to secondhand smoke:

  • 3,355 Alameda County patients aged 0 to 5 years were screened for exposure to environmental smoke, of which 890 were identified with exposure
  • 147 parents/caregivers were referred to the California Smokers' Helpline

"In the Primary Care Clinic we have developed a process that identifies smokers who live with our patients at every clinic visit and then tailor our interventions to counsel, refer to the California Smoking Quit-line, and provide nicotine replacement therapy to the parents and guardians of our patients."
- 2010-11 Contractor Report

Indicator 14: Baby-Friendly Hospitals [more]

Number of birthing hospitals that adopt WHO steps for obtaining Baby-Friendly designation (also Outcome 4A)

How do we compare?

Nationally, 100 Hospitals & Birth Centers in US are designated Baby-Friendly Hospitals

CA: 31 Hospitals and Birth Centers in Sept 2010

County: Kaiser Hayward has Baby-Friendly designation

2010-2011 Results

The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding.


As of 2011, two hospitals (Alameda County Medical Center, Washington) began to adopt the ten steps towards Baby-Friendly designation.

Outcome 4B

Children Have High Quality Early Learning Opportunities

Indicator 1: Stronger and with Fewer Behavioral Concerns [more]

Proportion of children screened in classrooms with Mental Health or Quality Counts consultation who demonstrate stronger protective factors and fewer behavioral concerns on DECA

How do we compare?

Nationally, 81% of children show resilience compared to 15% with behavioral concerns

2010 - 2011 Results

No data to report.

Indicator 2: Receiving Inclusion Services [more]

Proportion of families receiving F5AC services that secured and retained child care after receiving inclusion services

How do we compare?

There are no national data regarding the extent to which inclusive child care is available. In one study in North Carolina, 34% of a statewide sample of child care centers was found to enroll at least one child with disabilities. Inclusive centers, which serve children with and without disabilities, were significantly more likely to be of high quality than non-inclusive centers. Parents of children with special needs report that inadequate child care keeps them from working, but the scope and nature of this problem is not well understood.


2010-2011 Results

Of 967 calls to Inclusion staff at the Resource and Referral agencies, 241 (25%) were requests for child care from parents of children with special needs. Of those, 79 (33%) received child care as a result.

Indicator 3: Expelled from Child Care or Preschool [more]

Proportion of children under age 5 who are expelled from child care or preschools due to behavioral problems

How do we compare?

Nationally, 6.7 per 1,000 children are expelled from state pre-schools. In California, as many as 7.50 per 1,000 children are expelled from state preschools.



2010 - 2011 Results

No data to report

Indicator 4: Access to Quality Child Care [more]

Proportion of ECE sites receiving quality consultation with improved environmental rating scale (Harms/Clifford) scores by domain and CLASS scores for teacher – child relationship

How do we compare?

There are greater benefits to children's development when ECE quality is in the good to excellent range (a score of 5 or better on Harms/Clifford scales). However, a Rand study of the quality of preschools in California showed that 16% of children are in programs that fall below a score of 3 (minimally acceptable), and only 22% of programs score 5 or higher.


Beginning in 2007, the Los Angeles County, CA, Office of Child Care began a quality rating pilot program (QRIS program) called the Steps to Excellence Project (STEP) in 228 programs (38%) of the total number of licensed child care programs in the county.


2010-2011 Results

Two infant-toddler classrooms exceeded a score of 5.00 in 5 of 7 domains of the Harms/Clifford, including space and furnishings, interactions, and provisions for parents and staff.


Average Health & Safety (Personal Care Routines) on ECERS and ITERS improved > 1 pt. and exceeded 5.00 in 2 infant-toddler classrooms.


Average Program Structure domain improved > 1pt. on FCCERS and ITERS and exceeded 5.00 in 9 family child care programs and 2 infant-toddler classrooms.


Activities domain on ITERS also improved > 1 pt.


A follow-up evaluation of 13 of 21 family child care homes that participated in our Quality Improvement program showed quality improved modestly and these improvements were maintained 2-4 years later. Greatest improvements were sustained in health and safety-related practices, an essential ingredient of quality early care and education.

Indicator 5: ECE College Students Obtain Higher Degree [more]

Proportion of ECE students who receive supports to complete a higher education degree, who graduate within 3 years

How do we compare?

In 2004, the Lumina Foundation for Education launched "Achieving the Dream: Community Colleges Count," a national initiative aimed at improving success among community college students, particularly low-income students and students of color. Close to half of the students who begin at community colleges with the intention of earning a certificate or degree do not achieve their goal and are not enrolled in any college or university after six years. However, 60% of the F5AC-funded Emerging Teacher Program cohort students at Merritt College obtained an AA-degree equivalent in 3 years. Based on this and other positive findings from the cohorts, F5AC moved to fund cohort programs and to cease funding to stipend-only programs at the Community Colleges.

2010-2011 Results

4% (19/509) of students enrolled in Corps AA degree program in 2010-2011 obtained an AA degree or became "transfer-ready."

Indicator 6: Child Development Permit Progress [more]

Number of Corps members and other ECE students applying for first-time Child Development Permits

How do we compare?

Permit level is considered an indicator of ECE educator competency. County wide, 84 new permits were issued by CA CTC (2007-08 Annual Report)


2010-2011 Results


63 of 509 (12%) of Corps AA degree students obtained their Permit for the first time.

Indicator 7: Child Development Permit Advancement [more]

Number of Corps members and other ECE students applying for a Child Development Permits at a higher level

How do we compare?
2010-2011 Results

113 of 509 (22%) of Corps AA degree students advanced to a higher Permit level.

Indicator 8: ECE College Graduates Stay in Field [more]

The number of AA and higher degree graduates who continue to work in the field

How do we compare?

Nationally, only 30% of center-based teachers and administrators had a 4-year college degree and less than half of home-based providers had education beyond high school.


2010 - 2011 Results

Degree attainment and workforce retention results will be available at the end of FY 2012-13.

Outcome 4C

Entering Kindergarteners are “Ready To Learn”

"[My daughter] is more... [open] to... doing things without me by her side at all times. She is now not afraid to go to school since joining this [parent-child playgroup]... It's been a great experience for her and myself."


Starting in 2008, Applied Survey Research conducted annual studies of children’s readiness for kindergarten at select schools with the highest number of children at risk for poor outcomes. In 2010, analyses showed connections between child health, positive parenting attitudes, early learning opportunities and early intensive family supports that contributed to children’s readiness for school, underscoring the value of providing supports to families in these areas.

Indicator 1: Children Reading, Storytelling, Singing Daily [more]

Proportion of families receiving F5AC services who report reading, storytelling or singing to their children daily

2010-2011 Results

Reading, telling stories and singing to children support parent/child relationships. This year, 88% of families that received home visiting supports reported spending time with their child by sharing stories and songs daily.



88% Intensive Family Services (n=861)

87% Special Start (n=444)

91% Teen (n=274)

83% Your Family Counts (n=143) 


Our community grants recipients reported:


335 families read, told stories, or sung to their children daily

283 families had library cards
3,563 children’s books were distributed to parents and providers

Indicator 2: Children Ready for Kindergarten [more]

Proportion of children receiving services enter Kindergarten ready for school per KOF profiles

2010-2011 Results

Children with formal preschool experience tended to have better readiness outcomes; For children without prior preschool experience, participation in a 5-6 week F5AC Summer Pre-K program provides a measurable boost to their readiness for Kindergarten.


33 Summer Pre-K (SPK) classrooms in 9 school districts served 504 children. 10 of these 33 sites were funded by the Long Foundation in communities determined as "high need."  With the additional support from Long Foundation, SPK expanded to include new partner districts: Castro Valley and Pleasanton Unified.


According to the 2010 School Readiness Assessment Report:

  • 58% of the children studied were proficient in all domains, but 8% had needs in all domains
  • Child well-being (not appearing hungry, tired, or ill) was the strongest predictor of readiness;
  • Families who received specific information about how ready their child was for school prior to kindergarten and/or who reported more positive attitudes toward parenting had children who were more ready
  • Participation in the Intensive Family Support Home Visiting program was also associated with gains in readiness for children already at great risk for poor outcomes

Indicator 3: Children Move to 1st and 2nd Grade Without Delay [more]

Proportion of children who received F5AC services who successfully matriculate to 1st and 2nd grade

2010-2011 Results:

Project LAUNCH funds programming that encourages early identification of developmental concerns and linkages to supports for young children, and offers parenting engagement strategies to improve children's readiness for school. Through the US Department of Health and Human Services, Administration for Children and Families, F5AC received a grant to study children's school readiness, and their progress through 2nd grade, in East Oakland. Year one of the study will be completed in early 2012.

Children Have Access To Health, Mental Health And Developmental Services
Children Have High Quality Early Learning Opportunities
Entering Kindergarteners are “Ready To Learn”

This Annual Report's Main Sections: