Emergent Issues Affecting Early Intervention/ Early Childhood. Workforce Development for Inclusion in Early Childhood November 4, 2017 Washington, DC

Transcription

1 Emergent Issues Affecting Early Intervention/ Early Childhood Workforce Development for Inclusion in Early Childhood November 4, 2017 Washington, DC

2 Conversation Points Changing Demographics Emergent Trends Developmental Screening Initiatives Autism Adverse Childhood Experiences Workforce Issues

3 Changing Demographics

4 Births in the United States 4,400,000 4,300,000 4,316,233 4,200,000 4,100,000 4,000,000 3,999,386 3,953,590 3,952,841 3,932,181 3,988,076 3,978,497 3,900,000 3,800,000 3,700,

5 Birth through 4 Population Millions 20,300 20,200 20,100 20,000 19,900 19,800 19,

6 Race/Ethnicity, Birth through Hispanic 26% Non-Hispanic Native Hawaiian/Pacific Islander 0.5% Non-Hispanic 2+ race 5% Non-Hispanic Asian 5% Non-Hispanic American Indian & Alaska Native 1% Non-Hispanic Black 14% Non-Hispanic White 50%

7 Children in Immigrant Families 26% 25% 25% 25% 24% 24% 24% 24% 24% 24% 23% 23% 23% 22% 22% 22% 21% 21%

8 Children <5 Living in Poverty % % 24% 25% 26% 26% 25% % 0% 5% 10% 15% 20% 25% 30%

9 Children Living in Extreme Poverty % 9% % 10% 10% 10% 10% % 0% 2% 4% 6% 8% 10% 12%

10 Children <6 in Low Income Working Families % % 27% 27% % % 25%

11 Children <6 with No Parent in the Workforce % 9% % % % 10% 10% %

12 Children in Single Parent Homes % 35% 35% 35% 35% 35% % %

13 Children Impacted by Food Insecurity % % % % % %

14 Children (Ages 3-4) Not Attending Preschool % 53% % 54% 54% % % 49% 50% 51% 52% 53% 54%

15 Children (Ages 3-4) Not Attending Preschool by Income 70% 64% 63% 63% 63% 60% 50% 48% 45% 45% 46% 40% 30% Below 200% FPL Above 200% FPL 20% 10% 0%

16 Low Birthweight 8.25% 8.20% 8.15% 8.10% 8.05% 8.20% 8.10% 8.10% 8.10% 8.00% 7.95% 7.90% 8.00% 8.00% 8.00%

17 Children with Special Health Care Needs 25% 20% 15% 10% 13% 14% 19% 20% 5% 0%

18 Emergent Trends

19 Trends with Impact Developmental Screening Initiatives Autism Identification Adverse Childhood Experiences Neonatal Abstinence Syndrome (NAS) Impact on Foster System and Early Intervention

20 Developmental Screening Initiatives

21 Parents greater than 200% FPL 22% Parents less than 200% FPL 31% Parental Concerns about Development All Parents 26% 0% 5% 10% 15% 20% 25% 30% 35%

22 Affordable Care Act Periodicity Requirements Developmental Screenings 9, 18 and 30 months Autism Screening: 18 and 24 months Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons. Developmental Screening

23 Learn the Signs, Act Early CDC Initiative Home Visiting Initiatives Early Intervention MCH Priorities Developmental Screening

24 Autism

25 Autism and Developmental Disabilities Monitoring Network

26 CDC Estimates in 68 children in the United States have autism Boys: 1 in 42 Girls: 1 in % increase from 1 in 88 reported in 2008 More than double the 1 in 150 reported in 2000

27 Adverse Childhood Experiences (ACES)

28 Definition Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being ACEs include: Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Substance Misuse in Household Domestic Violence Household Mental Illness Economic Hardship Parental Separation or Divorce Parental Incarceration

29 Key Points Economic Hardship is the most common adverse childhood experience Prevalence increases with child s age Abuse of drugs/alcohol, neighborhood violence and occurrence of mental illness most commonly reported 46% of children in the U.S. have experienced at least one ACE

30 Children Aged Birth to 17: Percentage having had zero, 1 or 2, or 3+ ACEs Zero experiences: 54% 1 or 2 experiences: 35% 3+ experiences: 11% Four most common ACEs: Economic Hardship: 26% Divorce:20% Alcohol/Drugs: 11% Violence and Mental Illness: 9%

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33 State Part C Efforts Extensive Efforts Some Efforts Beginning to Address Not at this time PERCENTAGE OF RESPONDENTS PERINATAL SUBSTANCE USE ZIKA VIRUS LEAD POISONING FETAL ALCOHOL SYNDROME OTHER ADVERSE CONDITIONS

34 Neonatal Abstinence Syndrome (NAS)

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36 36 Drug Overdose Rates by State US Resident Overdose Deaths by State, NH 34.3 VT 16.7 MA 25.7 RI 28.2 CT 22.1 NJ 16.3 DE 22.0 MD 20.9 DC 18.6 Data Source: CDC Wonder 11.3 Age-Adjusted Rate Per 100,000 Population

37 Changes from Drug Overdose Deaths per 100,000 Residents Maryland Delaware Florida Maine 4 7 Illinois Missouri Indiana Source: National Center for Health Statistics, CDC

38 Opioid Prescriptions Opioid pain relievers and benzodiazepine sedatives are commonly prescribed in the United States. Overprescribing of opioid pain relievers can result in multiple adverse health outcomes. Wide variation exists from one state to another Need for state monitoring of prescribing patterns

39 Prescribing Rates per 100 Persons United States Opioid pain relievers Long-acting extended release opioid pain relievers High-dose Opioid pain relievers Benzodiazepines

40 Prevalence of Maternal Opioid Use Rate per 1,000 births/year

41 Prevalence of NAS Rate per 1,000 births/year

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43 Definition of NAS Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome that presents in newborns after birth when transfer of harmful substances (both legally prescribed or illegal) from the mother to the fetus abruptly stops at the time of delivery. Baby with symptoms Elevated Finnegan scores Positive screen (mom or baby) NAS

44 Infant Characteristics Diarrhea Excessive crying or high-pitched crying Excessive sucking Fever Hyperactive reflexes Increased muscle tone Irritability Poor feeding Seizures Sleep problems Slow weight gain Stuffy nose, sneezing Sweating Trembling (tremors) Vomiting Rapid breathing

45 Potential Complications Birth defects Low birth weight Premature birth Small head circumference Sudden infant death syndrome (SIDS) Problems with development and behavior Mother-Baby Relationship

46 Journal of Pediatrics Short Term Effects Nicotine Alcohol Marijuana Opiates Cocaine Methamphetamine Fetal Growth Effect Strong effect No effect Effect Effect Effect Anomalies No consensus on effect Strong effect No effect No effect No effect No effect Withdrawal No effect No effect No effect No effect * Neurobehavior Effect Effect Effect Effect Effect Effect Growth No consensus on effect Strong effect No effect No effect No consensus on effect * Lomg Term Effects Behavior Cognition Effect Strong effect Effect Effect Effect Effect Strong effect Effect No consensus on effect Effect * * Language Effect Effect No effect * Effect * Achievement Effect Strong effect Effect * Effect * * Limited or no data available

47 Foster Care and Child Maltreatment

48 Children Subject to Maltreatment Investigation, Birth through 4 46% 45% 44% 42% 40% 40% 40% 41% 41% 41% 38% 38% 36% 34%

49 Foster Care Placement Birth to Five 45% 40% 37% 38% 38% 40% 40% 40% 35% 34% 30% 25%

50 How do we prepare a workforce to address these populations

51 Personnel Shortages 90.00% 80.00% 70.00% 80.95% 69.05% 76.19% 60.00% 50.00% 45.24% 40.00% 30.00% 20.00% 10.00% 21.43% 28.57% 9.52% 9.52% 14.29% 7.14% 23.81% 23.81% 0.00%

52 What geographic areas are the most difficult to find providers? 37 NUMBER OF STATES 17 7 URBAN RURAL OTHER

53 What are the skills and competencies they will need?