Measuring Collective Change

First 5 Orange County is carefully watching several indicators to help determine whether our work is contributing toward achieving the vision that all children reach their full potential. First 5 Orange County is one of many organizations influencing these measures.

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Moving in right direction

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Moving in wrong direction

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No change

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Baseline only

Three “outcome” indicators relate to children’s readiness for kindergarten

Desired Trend Progress Indicator
B \
Proportion of children who are ready for Kindergarten

Source: Early Development Index
C \
Gap in children’s likelihood for being ready for Kindergarten (Disparity Index)

Source: Early Development Index
B \
Proportion of neighborhoods whose children are ready for kindergarten

Source: Early Development Index

Well-Child Visits, Screenings, and Linkage to Services

Desired Trend Progress Indicator
B \
Percentage of children on Medi-Cal completing well-child visits in the first 15 months of life

Source: CalOptima, HEDIS Measure W15
B \
Number of children ages 0-3 screened/entered into the OC Children’s Screening Registry

Source: OC Children’s Screening Registry
C \
Age of children entered into the OC Children’s Screening Registry

Source: OC Children’s Screening Registry
B \
Percentage of kindergartners whose teachers rate them as being in good / very good health

Source: Early Development Index
C \
Percentage of kindergarteners whose teacher believes they have a special need but have no IEP

Source: Early Development Index

Resilience Among Children and Families

Desired Trend Progress Indicator
C \
Children’s social and emotional vulnerability (Resilient Families measure)

Source: Early Development Index
C \
Gap between the percentage of young children who are eligible and enrolled in CalFresh (Resilient Families measure)

Source: Orange County Social Services Agency; California Department of Social Services
C \
Percentage of young children with four or more ACES

Source: OC Children’s Screening Registry
C \
Number/ rate of maltreated / neglected children ages 0-5

Source: CWS/CMS 2020 Quarter 2 Extract
C \
Number of families with children ages 0-5 experiencing homelessness

Source: HMIS

Quality Infant and Toddler Care

Desired Trend Progress Indicator
B \
Availability of infant and toddler child care

Source: Orange County 2020-2025 LPC Needs Assessment
B \
Availability of subsidized infant and toddler child care

Source: Orange County 2020-2025 LPC Needs Assessment
B \
Percentage of early care and education programs participating in Quality Start OC

Source: iPinwheel; Community Care Licensing Division

Measuring System Change

First 5 Orange County facilitates discussion with our funded partners and community or countywide collaboratives about how we can create seamless systems of care for young children and families. We work with funded partners and collaboratives to gauge progress toward positive “systems” change.

2020/21 was the pilot year for evaluating systems change work, and among the funded partners and collaboratives we engaged, we saw the following progress.

Funded Partners

There were 28 Funded Partner responses submitted—25 from the school districts and 3 from other organizations

chart showing progress made by First 5 OC funded partners

Collaboratives

Five collaborative groups assessed their progress toward systems change in the pilot year, with the following results.

Chart showing progress made by First 5 OC collaboratives

Measuring Program Investments and Our Annual Work

During FY 2019/20, First 5 Orange County served:

1000

children ages 0 to 5

1000

family members

Flagship Services

In February 2020, First 5 Orange County approved three-year funding for its flagship services:

A pediatrician examines a happy baby with a stethoscope

Prenatal-to-Three

$14,275,000 over the next three years to support agencies that provide prenatal-to-three services

Believing in the vital importance of early prevention and intervention during children’s most rapid stage of brain development from birth to age 3, First 5 Orange County invests in services that help mitigate the impacts of childhood adversity and foster long-term individual and family resilience. Our funds support prenatal care, hospital screenings, home visiting, mental health and parenting support and resources. We employ a two-generation approach to cultivate child and caregiver well-being while strengthening the foundational relationships between young children and caregivers that fortify children’s healthy development.

children with their teacher in a circle playing a game on the blacktop at school

School District Partnerships

$17,000,000 over the next three years to support our school district partnerships

Our funding supports each of Orange County’s 25 elementary school districts as they prioritize early childhood, collect Early Development Index data, and develop the system of care needed so that every child starts kindergarten with the opportunity to achieve their full potential. Districts engage with parents and community partners to create linkages between early care and education, health and family support systems.

A young girl rests on her dad's shoulder

Homeless Prevention

$3,750,000 over the next three years to support system improvement work along with funding shelter operations

Providing safe, caring homes in times of crises, First 5 Orange County funds shelters that help pregnant mothers and families with young children. First 5 Orange County also funds the Family Solutions Collaborative. This collaborative works on a system level to align resources for homeless families in a streamlined process.

To read more about First 5 Orange County’s investments and accomplishments, see our annual report.

This indicator measures Kindergarten Readiness as the proportion of children who are on track (25th percentile or higher) on all Early Development Index (EDI) domains. This measure helps identify the contributions of First 5 Orange County to make positive change in Orange County for children and families.

The Early Development Index (EDI) measures five developmental areas that are known to affect well-being and school performance: 1) Physical Health & Well-Being, 2) Social Competence, 3) Emotional Maturity, 4) Language & Cognitive Development, 5) General Knowledge & Communication.

For each child’s record, an average score on each of the five developmental areas is calculated and then compared against three pre-established cutoff categories (using percentiles) — “vulnerable” (0-10%), “at risk” (10-25%) and “on track” (25-100%).

In 2019:

  • 0% of kindergarteners were vulnerable on physical health and well-being
  • 6% of kindergarteners were vulnerable on social competence
  • 7% of kindergarteners were vulnerable on emotional maturity
  • 6% of kindergarteners were vulnerable on language & cognitive development
  • 7% of kindergarteners were vulnerable on general knowledge and communication

This indicator measures Kindergarten Readiness as the proportion of children who are vulnerable (bottom 10th percentile) on each of the five Early Development Index domains, by race and ethnicity. This measure helps identify the contributions First 5 Orange County’s positive contributions in the county for equity.

Between 2015 and 2019, 35 neighborhoods (15%) had an increase in their children’s readiness for kindergarten, while 34 neighborhoods (14%) had a decrease. In most of the neighborhoods (171 neighborhoods or 71%), there was no critical difference in children’s readiness over time.

EDI data help us to understand how neighborhoods are preparing children for kindergarten. If children in a neighborhood are more ready for kindergarten over time, the neighborhood is growing its ability to prepare children for school and life. Conversely, if a neighborhood’s children are less ready for kindergarten over time, more neighborhood support is needed. Analysis is based on the percentage of children who are vulnerable on one or more Early Development Index (EDI) domains, and the critical difference between 2015 and 2019 data.

Between 2017 and 2020, the percentage of children under 15 months of age receiving their well-child visit grew by almost 16 percentage points, from 51.0% to 66.7%. 

Well-child visits are essential to provide an opportunity to track growth and development (e.g., developmental milestones, social behaviors, and learning); discuss concerns about a child’s health; and receive scheduled vaccinations to prevent illnesses. Ensuring that children complete their well-child visits is crucial to supporting children on the path to good health and setting them up to be successful in life.

The Health Care Effectiveness and Data information Set (HEDIS) is a set of standardized performance measures developed to measure, report, and compare quality across health plans. Orange County’s managed healthcare organization, CalOptima, assesses the percentage of CalOptima members who turned 15 months old during the measurement year and who had well-child visits with a Primary Care Physician (0, 1, 2, 3, 4, 5, or 6 or more visits).

Between 2019 and 2020, there was a 36% and 32% increase in the number of children screened and number of screenings, entered into the Registry, respectively. Children often receive more than one screening, hence data on children and screenings are presented.

One in six children under the age of three have a developmental delay, with estimates that more than 80% of these children do not receive the vital early intervention services that can help them close that developmental gap.” Research consistently shows that the earlier a delay is recognized, and intervention is begun, the better the chance the child has of substantial improvement. This indicator measures the number of children entered into the OC Children’s Screening Registry.

The OC Children’s Screening Registry launched in 2018, with 2019 the first year of 12 full months of developmental screening data. Because of its relative newness, there are a limited number of children included in the Registry. This will likely change as more providers use the Registry and more children are included.

In 2020, nine out of 10 of the children with developmental screenings entered into the Registry were children younger than three years old. Of those, the greatest proportion were between 1 and 2 years old. The average age, in months, of a child’s first screening in the OC Registry was 19.7 in 2020, slightly higher than the average age in 2019 (19.5 months).

One in six children under the age of three have a developmental delay, with estimates that more than 80% of these children do not receive the vital early intervention services that can help them close that developmental gap. Research consistently shows that the earlier a delay is recognized, and intervention is begun, the better the chance the child has of substantial improvement. This indicator measures the average age of children at the first time they are entered into the OC Children’s Screening Registry.

In 2019, 60.4% of kindergarteners were rated as being in good/very good health by their teachers and only 2% were rated in poor or very poor health.

Health status during childhood sets young people on a path toward good or poor health in adulthood. Monitoring the overall status of children’s health and working to increase the percentage of kindergartners whose teachers rate them as being in good or very good health is a critical step as it allows policymakers, service providers, funders, and others to identify population trends and needs, and develop appropriate investments and strategies to support children.

The percentage of kindergarteners whose teachers believe they have a special need but have no Individualized education Plan (IEP) dropped 9 percentage points from 44.1% in 2015 to 35.6% in 2019.

The early years of a child’s life are critical for building the foundations of learning, health, and wellness needed for success in school and later in life. This is because the connections in a baby’s brain are most adaptable in the first three years of life. A lack of an IEP indicates that the child may not be receiving the early intervention services that would support their healthy development.

The proportion of Orange County kindergarteners who are vulnerable on their social-emotional competence has remained relatively steady and was at 9.7% in 2019.

Children’s social and emotional health affects their overall development and learning. Social-emotional development is influenced by the quality of nurturing attachment and stimulation that a child experiences in the earliest years of their lives. Early and appropriate interventions that focus on social-emotional development can help to mitigate the effects of negative experiences in ways that lead to improved cognitive and social-emotional outcomes.

The gap between the percentage of eligible children 0-5 and actual participation in CalFresh is growing. In FY 2018/19, 29.8% of CalFresh beneficiaries under age 18 in Orange County were children from birth to five years old (25,503 children 0-5 of the 102,285 children under 18 receiving CalFresh). Also, in 2018/19, 59.0% of the overall eligible population in Orange County received CalFresh assistance, as indicated by the Program Reach Index.

CalFresh is an entitlement program that provides monthly benefits to assist low-income households in purchasing food. This indicator uses CalFresh enrollment as a proxy to measure the Resilient Families protective factor of: Concrete supports in times of need. By identifying barriers and working to increase the number of families enrolled in CalFresh, we are creating a community that will provide opportunities for all children and families to thrive and succeed. Please note that we will continue to refine this metric with our partners.

Orange County Social Services Agency provided the data related to enrollment in CalFresh (pulled from Annual Report on the Condition of Children in Orange County), while eligibility was calculated using information provided by California Department of social services.

In 2020, the first full year of inclusion of ACEs data into the screening registry, there were 4,311 children with PEARLS (Pediatric ACEs and Related Life Events Screener) screenings entered into the OC Children’s Screening Registry.

Adverse Childhood Experiences, or ACEs—such as child abuse, exposure to violence, exposure to parental substance use/misuse, and poverty—can have negative, long-term impacts on health and well-being. Data shows that 1 in 6 adults experienced four or more ACEs and that preventing ACEs could reduce the number of adults with depression by as much as 44%. By screening children for ACEs and responding with trauma-informed care we can improve the health and well-being of children and families, lower long-term health costs and significantly improve quality of life for individuals and the community.

The OC Children’s Screening Registry launched in 2018, collecting developmental screening data. PEARLS data about ACEs screenings was added later, with 2020 the first year of 12 full months of data. Because of its relative newness, there are a limited number of children included in the Registry. This will likely change as more providers use the Registry and more children are included.

As 2020 is the first full year of inclusion of the PEARLS data into the screening registry, only baseline (not trend) data are available. In 2020, fewer than 2% of children with PEARLS data entered into the screening registry had a score of four or more ACEs.

Child maltreatment and neglect are serious public health problems and adverse childhood experiences (ACEs) that can have long-term effects on health and wellbeing. In Orange County, children under six made up the greatest proportion of substantiated child abuse allegations: children less than one year of age comprised 14.0% of substantiated child abuse allegations and children one to five years old made up 29.9% of substantiated allegations, totaling 43.9%.

Child Welfare Services / Case Management System, 2020 Quarter 2 Extract

There has been a 10% decline in the number and rate of substantiated reports of abuse and neglect since 2014.

When children grow up in safe and stable homes, their chance for success in school and life dramatically increases.  First 5 Orange County is bringing visibility to this critical population that could benefit from early intervention.

Homeless Management Information System

In 2019/20, there was enough licensed capacity to serve only 5% of the county’s children younger than three years old. 

In Orange County, 60% of children ages 0-4 have all parents working. Yet, there are approximately 21 infants/toddlers for each licensed slot available. Even if only one-third of infants and toddlers in Orange County required childcare, there would still only be enough licensed capacity for 1 in 7 children. Increasing the number of quality slots available for infants and toddlers will help provide a stable, secure setting to support the health, social and emotional development for children and their families.

Local Planning Council (LPC) Needs Assessment, 2020-2025

In 2019/20, an estimated 53% of children ages 0-2 were eligible to receive subsidized care, yet only 6% were actually served, due to a lack of supply in subsidized care.

More than half of children 0-4 throughout the County are eligible for state or federal subsidies based on income. Subsidized programs provide the most vulnerable children with access to childcare. By measuring the number of subsidized child care slots available for infants and toddlers, we can continue to work to increase the number of child care slots to meet the need for children and their families.

In March 2021, there were 479 early care and education programs participating in Quality Start Orange County. Of these 479 programs, 289 were center-based programs, which represents roughly 30% of all licensed center-based care programs in Orange County. Another 63 programs were Family Child Care (FCC) Homes, which represents roughly 13% of all licensed FCC homes in the county.

Quality Start OC is a collaborative, county-wide effort to support and advocate for quality early care and education in Orange County. When looking at cost-benefits, quality early childhood education (ECE) programs for low-income children ages 0-5 have been documented to produce a substantial return on investment. By increasing the number of programs participating in Quality Start OC, we are creating more opportunities for children to have access to quality ECE programs and creating better futures for them and their community.

iPinwheel (data system for Quality Start Orange County); Community Care Licensing Division.