Evidence-based Practice and Community Metrics Jan Figart, MS, RN Community Service Council

Evidence-based Practice and Community Metrics

Jan Figart, MS, RNCommunity Service Council

Home Visitation Model

The Adverse Childhood Experiences (ACE) Study

• Major American research project that poses the question of whether and how childhood experiences affect adult health decades later

• Provides compelling evidence that:– Adverse childhood experiences are surprisingly common– ACE’s happen even in “the best of families”– ACE’s have long-term, damaging consequences

• Findings reveal powerful relationships between emotional experiences as children and physical and mental health as adults

Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.”

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The Adverse Childhood Experiences (ACE) Study Pyramid

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Conception

Death

Mechanisms by which Adverse Childhood Experiences Influence Health and Well-being throughout the Lifespan

Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.”

Adverse Childhood Experiences…

• Recurrent physical abuse• Recurrent emotional

abuse• Sexual abuse• An alcohol or drug abuser• An incarcerated

household member

• Someone who is chronically depressed, suicidal, institutionalized or mentally ill

• Mother being treated violently

• One or no parents• Emotional or physical

neglect

Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “What are Adverse Childhood Experieinces (ACE’s).”

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…Lead to Health-Risk Behaviors…

• Smoking• Overeating• Physical inactivity• Heavy alcohol use• Drug use• Promiscuity

Source: The Adverse Childhood Experiences Study website: www.acestudy.org

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…Which Cause Disease, Disability and Social Problems in Adulthood

• Heart disease• Cancer• Chronic lung and liver

disease• Stroke • Diabetes• Sexually transmitted

diseases

• Nicotine addiction• Alcoholism• Drug addiction• Obesity• Depression• Suicide• Injuries• Unintentional pregnancy

Source: Felitti, Vincent J., “The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead;” CDC Media Relations, May 14, 1998, “Adult Health Problems Linked to Traumatic Childhood Experiences.”

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Prepared by the Community Service Council of Greater Tulsa

Age of Children of Confirmed Abuse and NeglectOklahoma, FY 2011

Source: Oklahoma Dept. of Human Services, Children & Family Services Division.

1,274

1,399

2,252

1,869

1,316

(15.7%)

(17.3%)

(27.8%)

(23.0%)

(16.2%)

Under 1 1-2 3-6 7-11 12 & older

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Average Daily Membership and Percentage of Children Enrolled in Special Education, by School District

Tulsa County County, School Year 2010-11

Source: Oklahoma State Department of Education, Education Oversight Board, Office of Accountability, Profiles 2011 Reports.

Berryhill Bixby BrokenArrow

Collinsville Glenpool Jenks Keystone Liberty Owasso SandSprings

Skiatook Sperry Tulsa Union0

10,000

20,000

30,000

40,000

50,000ADM

0%

10%

20%

30%

40%

50%Percent in Special Education

ADM % Spec. Ed.

ADM 1,208.9 5,013.216,675.5 2,652.6 2,384.6 10,044 384.6 596.4 9,107.5 5,102.3 2,541.8 1,219.840,808.214,835.1

% Spec. Ed. 9% 14.2% 14.5% 12.9% 12.6% 14.8% 14.9% 16.2% 10.4% 12.7% 12.7% 12.5% 14.6% 10.2%

Tulsa County total ADM = 112,575; percentage in special education = 13.4%

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Juvenile Arrests, by Type of CrimeTulsa County, 2001 through 2011

Source: Oklahoma State Bureau of Investigation, Uniform Crime Reports.

Index crimes Drug related Alcohol related Other crimes0

500

1,000

1,500

2,000

2,500

3,000

3,500Number of arrests

2001 2002 2003 2004 2005 2006

2007 2008 2009 2010 2011

A total of 2,852 juvenile arrests were made in Tulsa County in 2011, for a rate of 85.2 per 1,000 juveniles age 10-17, down from 5,954 arrests for a

rate of 91.9 in 2001.

Includes murder, rape, robbery aggravated

assault, burglary, larceny, and motor vehicle theft.

Includes sale/manufacturing

and possession of drugs.

Includes driving under the influence, liquor law violations, and drunkenness.

Includes other assaults, disorderly conduct, curfew & loitering, runaway and all other non-traffic offenses

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Source: Centers for Disease Control, Youth Risk Behavior Surveillance System; Oklahoma State Department of Health, OK2SHARE.

47.8%

22%

9.9%

22.2%

26.5%

17.5%

30.6%

40.5%

18.7%

7.1%

18.4%

28.6%

12.3%

25.8%

43.1%

15.9%

5.5%

19.1%

23.2%

13.3%

26.8%

39%

17.2%

4.8%

16.8%

22.6%

11%

23.1%

38.3%

19.1%

4.2%

17.2%

22.7%

7.2%

19.7%

38.7%

23.1%

3.8%

25.6%

18.1%

8.2%

24.1%

Alcohol

Marijuana

Methamphetamine

Offered/sold/givenillegal drugs at school

Smoked cigarettesduring past month

Drove after drinkingalcohol in past month

Rode with drinkingdriver in past month

0%10%20%30%40%50%60%

2003 Oklahoma

2005 Oklahoma

2007 Oklahoma

2009 Oklahoma

2011 Oklahoma

2011 US

Youth Risk Behavior Survey:Summary of Alcohol, Other Drug & Tobacco Use

High School Students, Oklahoma, 2003 through 2011, and U.S. 2011

Used once or more during past 30 days...

Ever used...

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Source: Centers for Disease Control, Youth Risk Behavior Surveillance System; Oklahoma State Department of Health, OK2SHARE.

50%

5.8%

64.3%

17.7%

7%

14.2%

49.3%

6.5%

61.7%

16.4%

7.9%

15.9%

38.2%

50.9%

5.8%

59.6%

16.7%

5.9%

15.2%

49.6%

51.1%

4.7%

56.7%

22.7%

7%

16.4%

47.4%

50.5%

5%

57.1%

20.5%

6.3%

16.3%

50.8%

47.4%

6.2%

60.2%

18%

7.8%

15.2%

49.5%

Ever hadsexual intercourse

Had sex before age 13

Used condom last time

Used birth controlpills last time

Attempted suicidein past year

Overweight(according to BMI)

Physical activity for60 min/day 5 of past 7 days

0% 20% 40% 60% 80%

2003 Oklahoma

2005 Oklahoma

2007 Oklahoma

2009 Oklahoma

2011 Oklahoma

2011 US

Youth Risk Behavior Survey:Summary of Sexual Behaviors, Suicide & Physical Health

High School Students, Oklahoma, 2003 through 2011, and U.S. 2011

na

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1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2011

0

5,000

10,000

15,000

20,000

25,000

30,000Prison population

Oklahoma’s Prison PopulationFiscal Years 1950 - 2011

Source: Oklahoma Department of Corrections.

US incarceration rates (2011): Male: 938 per 100,000 people Female: 67 per 100, 000 people Total: 497 per 100,000 people

Oklahoma incarceration rates (2011): Male: 1,244 per 100,000 people Female: 142 per 100,000 people Total: 686 per 100,000 people

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Oklahoma's Rankings in Health Determinants, 2012 (part 1)According to United Health Foundation's State Health Rankings

Note: Missing data values represent years in which variables were not measured/ranked.

Source: United Health Foundation, “America’s Health Rankings.“

#47

#12

#45

#25

#39

#42

#11

#24

#29

Personal Behaviors

Prevalence of smoking

Prevalence of Binge Drinking

Prevalence of obesity

Community & Environment

High school graduation

Violent crime

Occupational fatalities

Infectious disease

Children in poverty

Air pollution

#0 #10 #20 #30 #40 #50

1992 2002 2012

Ranking: 1=best, 50=worst

Oklahoma's Rankings in Health Determinants, 2012 (part 2)According to United Health Foundation's State Health Rankings

Notes: Missing data values represent years in which variables were not measured/ranked. Updated data for “early prenatal care” were not available. Shown results are for 1991, 2001, & 2011.


#35

#15

#20

#47

#49

#45

#42

Public & Health Policies

Lack of health insurance

Public health funding (per capita)

Immunization coverage

Clinical Care

Early prenatal care

Primary Care Physicians

Preventable Hospitalizations

All Determinants

#0 #10 #20 #30 #40 #50

1992 2002 2012


Oklahoma's Rankings in Health Outcomes, 2012According to United Health Foundation's State Health Rankings

Note: Missing data values represent years in which variables were not measured/ranked.


#46

#40

#20

#39

#48

#42

#46

#44

Poor mental health days

Poor physical health days

Geographic disparity

Infant mortality

Cardiovascular deaths

Cancer deaths

Premature death

All Health Outcomes

#0 #10 #20 #30 #40 #50

1992 2002 2012


Oklahoma’s overall health ranking for 2012 is # 43

Home Visitation Model

Social Determinant Model


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sRace Comparison for Total Population and Children under 5

Oklahoma and Tulsa County, 2010

Source: US Census Bureau, 2010 Census.

59.3%

8.2%11.0%

1.6%

19.8%54.9%

12.6%

7.3%

2.5%

22.8%

72.2%

7.4%

8.6%

1.7%

10.1%

69.2%

10.7%

6.0%

2.3%

11.7%

White Black American Indian Asian Other/2+ races

Oklahoma Tulsa County

Under 5

Total Population

N = 591,982

N = 48,035N = 266,547

N = 3,642,361

Hispanic16.8%

Hispanic20.6%

Hispanic8.9%

Hispanic11.0%


Population Trends and Projections by Age GroupTulsa County, 1970 - 2030

Source: US Census Bureau, 1970, 1980, 1990, 2000, & 2010 Censuses; US Census Bureau, Population Estimates Division, Population Projections, 2000 - 2030.

6.3

6.6

7.4

7.4

7.7

7.7

8.5

16.6

17.1

18.2

18.9

18.4

19.8

25.9

9.2

9.7

9.7

10

10.1

13.5

10.7

47.8

50.5

52.6

51.9

52.2

49.1

46.2

17.5

14.1

10.4

10.4

10.4

9

8.1

2030

2020

2010

2000

1990

1980

1970

0% 20% 40% 60% 80% 100%

Percent of population

0-4 5-17 18-24 25-64 65-84 85+

1.9

1.4

1.2

.9

.6

Pro

ject

ions 2.5

2.1

Dem

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Living Arrangements of Related Children Under 18Tulsa County, 1970, 1980, 1990, 2000 & 2009-11 Estimates

Source: US Census Bureau, 1970, 1980, 1990, and 2000 Censuses; US Census Bureau, American Community Survey 2009-11.

Married Couple Male-headed Female-headed Other relatives0%

20%

40%

60%

80%

100% 1970 1980 1990 2000 2009-11 est.

1970 82% 1% 11% 4%

1980 74% 2% 16% 6%

1990 71% 3% 18% 5%

2000 65% 5% 21% 7%

2009-11 est. 60% 6% 24% 8%

Children living with 1 or both parents

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Ratio of Income to Poverty LevelPercentage of Total Population and Children

Tulsa County, 2007-11

Source: US Census Bureau, 2007-11 American Community Survey.

Total population Under 18 Under 6 6-170%

25%

50%

75%

Percentage of population

Below 100% Below 185% Below 200%

Below 100% 15.1% 22.6% 27% 20.2%

Below 185% 32.4% 43.7% 50.1% 40.2%

Below 200% 35.2% 46.8% 53.1% 43.4%

Family of Three, Tulsa County, 2012*

Source: Oklahoma Association of Community Action Agencies and the Oklahoma Asset Building Coalition, December 2009, The Self-Sufficiency Standard for Oklahoma 2009; 2012 HHS Poverty Guidelines, Federal Register, Vol. 77, No. 17, January 26, 2012, pp. 4034-4035; Oklahoma State Dept. of Human Services; U.S. Census Bureau, 2009-11 American Community Survey.

$75,495

$58,854

$38,277

$10,309$15,312

$19,090

$35,317

$21,410

WelfareWage

MinimumWage

PovertyWage

185% PovertyWage

Median FamilyIncome

(2006-08 ACS)

$0

$20,000

$40,000

$60,000

$80,000Annual Wage

Self-Sufficiency Wage = $39,978 ($18.93/hr)

Comparison of Wages: Self-Sufficiency, Welfare, Minimum, Poverty, 185% of Poverty, and Median Family Income

($4.88/hr) ($7.25/hr) ($9.04/hr) ($16.72/hr)

Notes: For the self-sufficiency wage, family of three consists of one adult, one preschooler and one schoolage child. Hourly wages given assume full-time, year-round employment. The 2009 poverty guidelines are being used until at least March 1, 2010. Welfare wage is the combined value of TANF, SNAP, & WIC.

Married-couple families w/ children <18($35.75/hr)

All families w/ children <18

Male-headed families w/ children <18

Female-headed families w/ children <18

($18.12/hr)

($27.87/hr)

($10.14/hr)

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Participation in Public Assistance ProgramsNumber of Participants and Percentage of Population Participating

Tulsa County, 2012

Source: Oklahoma Dept. of Human Services, Statistical Bulletin, September 2012; Oklahoma State Dept. of Education, Low Income Report for 2011-12; US Census Bureau, 2010 Census; Oklahoma State Department of Health-WIC Service, Caseload Report, October 2012; Oklahoma Health Care Authority, Monthly Enrollment Fast Facts November 2012.

121,054

79,699

3,974

8,854

3,485

85,722

2,581

35,153

6,116

19.8%

51.2%

17.4%

18.1%

10.1%

13.9%

1.7%

53.1%

9.2%

Soonercare Total (185%/100%)

Soonercare <19 (185%)

WIC Infants (185%)

WIC age 1-5 (185%)

Child Care Subsidy <5 (185%)

SNAP Total (130%)

TANF <18 (50%)

Elem. School Free Lunch (130%)

Elem. School Reduced Lunch (185%)

050,000100,000150,000

Number of Participants

0% 20% 40% 60%

Percent of Population

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Educational Attainment for Persons Age 25 & OlderTulsa County, 2009-11 Estimates

Source: US Census Bureau, American Community Survey 2009-11.

11.5%

26.2%

24.7%

8.2%

20.1%

6.3%

2.1%

0.9%

Less than high school

High school graduate

Some college

Associate degree

Bachelor's degree

Master's degree

Professional school degree

Doctorate degree

0% 5% 10% 15% 20% 25% 30%

Percent of persons 25+

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Documents

Evidence-based Practice and Community Metrics Jan Figart, MS, RN Community Service Council