Dear Friend of Spark NH,

Spark NH Needs Assessment

Spark NH's needs assessment was released last month. The report is intended to contribute to our understanding of the extent to which children in every New Hampshire community have access to the resources and experiences that promote their development- good health, strong families, positive early learning experiences. When there are limitations or gaps in our capacity to provide positive contexts for development, prospects for a healthy and prosperous future for individuals, families and communities in New Hampshire are jeopardized. The report documents a number of systemic gaps for many of New Hampshire's children and their families - gaps in developmental screening, limited access to essential services, gaps in availability of services, geographic and racial disparities, and a critical lack of information where we need it most. We intend to repeat a needs assessment periodically. If you have not had a chance to look at the report, you can find it at: http://sparknh.com/uploads/files/Need%20Assessment%2011-20-14%281%29.pdf  

I have reprinted the introduction/ executive summary here:  

A SMART INVESTMENT FOR ALL OUR FUTURES

Our future relies on the health and well-being of our children, their families, and the communities who nurture and support them. Since early experiences set the foundation for all of the development that follows, ensuring strong supports early in life is essential not only to children's health and well-being, but to the future health and well-being of our communities. In short, child development is community development. If we are to realize our children's and our community's full potential it is crucial that communities across our state provide the critical supports and resources young children and their families need to thrive.

There is a strong economic and social case to be made for such community-based support. When resources are grounded in research-based best practices and are provided at the appropriate time and for sufficient duration, they can have dramatic positive social and economic impacts on our communities. We know that investing in early childhood programs can yield up to a 10% annual rate of return that includes long-term individual benefits of increased income, as well as savings to society in reduced costs for special education, juvenile justice, welfare and unemployment.

Such investments provide an even greater rate of return for children and families living with multiple risk factors. We know from numerous studies that children from families with low incomes may benefit the most from comprehensive early childhood programs. Not only have these programs demonstrated improvements in

CREATING A COMPREHENSIVE SYSTEM

The report below documents a number of systemic gaps for many of New Hampshire's children and their families - gaps in developmental screening, limited access to critical services, gaps in availability of services, geographic and racial disparities, and a potentially dangerous lack of information where we need it most. All of these factors, if left unaddressed, will limit the developmental potential of our children, and therefore New Hampshire's potential for growth and success.   

Screening Gaps

As the first step to ensuring the healthy development of our children, having access to standardized research based screening practices is essential. As discussed in this report, national research suggests that clinical assessment alone, without the use of standardized screening tools, identifies fewer than 30% of children with developmental disabilities, while validated screening tools correctly identify such children at least 70% of the time. Unfortunately, this report also documents that fewer than 50% of children with a developmental disability or disabling behavioral problem are identified before they start school. Given that early identification can effectively reshape a child's developmental pathways, improving access to screening is a critical need for our state.

Access Gaps

Much like a traveler facing a ravine without a bridge, many families in the state face serious barriers that they have no or limited control over which limit the possibilities that are open to them.

For example, this report highlights:

• Barriers to Quality and Affordable Child Care: For a family of three at 200% of the Federal Poverty Level (FPL), the average cost of care for an infant in New Hampshire consumes more than one third of their household income, putting child care out of reach for many families whose incomes are low.
• Barriers to Early Education and School Readiness: While New Hampshire children enjoy almost statewide access to public kindergarten, most of this access is only to part-day programs. In 2012, only 37% of children enrolled in public kindergarten had access to a full day program.
• Barriers to Family Care: 52% of employed parents in NH did not have access to even a minimum of five paid sick days to care for a sick child.
• Barriers to Economic Sustainability: Even when all the adults in a family are working full time, 7% of their children continue to live in poverty in New Hampshire. One in four families with children under the age of 6 are sometimes or very often experiencing financial hardship covering basic needs, like food or housing.

Gaps in Availability of Services

New Hampshire supports a broad range of programs to aid families in need. As documented in this report however, such supports are limited in scope and do not meet the needs of all those who would otherwise be eligible.

Some of the most critical gaps include:

• Limited Access to Early Supports and Services. National estimates suggest that 13% of children ages 0-3 are at risk for developmental delays, and yet, due to state financial constraints, the Family Centered Early Supports and Services Program (FCESS) was only able to serve 4.4% for this age group in 2011-2012.
• Limited Access to Mental Health Professionals. As of a 2008 review, only 1 in 5 physicians reported having expertise in early childhood mental health issues and there were no child psychiatrists located in Carroll or Coos counties for physicians to refer to. As of 2012, about 1 of every 3 children ages 2 to 17 with problems requiring mental health counseling did not receive it.
• Limited Access to Appropriate Health Care. Three in ten children (30%) aged birth to 15 months in New Hampshire receiving Medicaid did not receive the recommended number of well-child visits and, similarly, one in four children (27%) ages 3-6 years with Medicaid did not receive recommended well-child visits
• Limited Access to Before/After School Programs. According to the After-school Alliance, although there are over 43,000 children in NH who are eligible to participate in federally funded afterschool programs, due to limited funding, fewer than a quarter of those are enrolled.

Gaps Based on Geography and Race

Where a child grows up in New Hampshire can provide differential opportunities for their health and well-being. In addition to high risk pockets located through the state, specific geographic areas have demonstrated a far higher prevalence of critically negative factors that can impede child and family well-being. For example, in Sullivan County, children are much more likely to be identified with a mental health disorder than other areas in the state and families are faced with a severe shortage of child care slots (only 64 slots available per 100 children) making it more difficult to maintain quality employment. In Coos County, emergency department visits for mental health reasons are significantly higher, children have the highest rate of tooth decay, have the highest asthma rates, as well as the highest rates of child maltreatment in the state (nearly three times the state average rate).

In addition to disparities arising from geography, New Hampshire is faced with growing racial disparities as well that are likely to continue to limit opportunities for growth and success among the populations impacted. For example, while about seven percent of White, non-Hispanic residents have incomes below the poverty line (7.3%), Hispanic residents of NH are more than twice as likely to be living below the poverty line (15.8%) and Black or African American residents are more than three times as likely to be living below the poverty line (24.2%). As a result of limited financial security, it is likely that these families will also experience a range of obstacles which will continue to negatively shape their futures, including: food insecurity, housing insecurity, and limited educational opportunities.    

Gaps in Information for Decision Making

Further complicating the above issues is a lack of reliable data to document where demand exceeds supply, or in some cases, to accurately gauge what the demand is so we can better understand what needs are and are not being met. New Hampshire needs more integrated information systems not only to improve efficiency and knowledge of services provided, but also to eliminate gaps or duplication of services and to assist families in navigating the complexity of systems of care and support. As outlined in this report, this fragmentation occurs across a broad range of areas.    

FILLING THE GAPS

If we were to provide a more coordinated and aligned system of services for New Hampshire children and families, it would have multiple, significant direct impacts on the future of our state. Addressing our state's gaps and challenges requires a multi-pronged approach emphasizing the importance of improved data systems, as well as implementing system wide and targeted programs with a history of demonstrated effectiveness.

Within this context, programs providing temporary financial or food assistance can be helpful, but they are frequently not sufficient to enable families to overcome their challenges and become fully self-sustaining. As discussed in this report, other programs and services such as job training and work supports, parent education, health care, home visiting and other family supports are critical to improving child health and developmental outcomes. Central to these efforts will be improved collaboration among agencies and programs with an eye towards decreasing duplication of services and efforts, providing greater access to services, and facilitating optimal use of scarce resources.

As the State of New Hampshire continues to work on these areas, Spark NH will look forward to continuing its efforts to support a coordinated, sustainable early childhood system that achieves positive outcomes for young children, their families, and their communities. By documenting where some of the critical gaps are in New Hampshire, this report reflects an important first step in understanding the needs of New Hampshire's children and families. By combining this effort with the multiple activities of the Spark NH Council and committees, we are one step closer to achieving our vision: that all New Hampshire children and their families are healthy, learning and thriving now and in the future. To learn about and join us in our efforts, please visit www.sparknh.org or contact me at lmilliken@sparknh.org.

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The Spark NH Data Committee will be taking a close look at the report and how to make it most useful in future iterations. We will be thinking about indicators that should be used to determine how well the early childhood system is coordinated and how well it works for young children and their families in New Hampshire. If you would like to contribute to this discussion, would like to join the committee or have feedback on the needs assessment, please contact me at lmilliken@sparknh.org.

Respectfully submitted,

Director, Spark NH