LCHS Community Assessment 2012 2013

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Community Assessment report for Head Start of Lincoln County, Oregon.

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LCHS Community Assessment 2012 2013

  1. 1. 2012-2013 Community Assessment Submitted to: Suzanne Miller, PhD Director On behalf of: Head Start of Lincoln County, Oregon(A Program of Community Services Consortium) Provided by: Joann Zimmer, MPAE
  2. 2. Community Assessment 2012-2013 TABLE OF CONTENTS1.0 Summary .........................................................................................................................1 1.1 Executive ......................................................................................................................... 1 1.2 Data ................................................................................................................................. 2 1.2.1 Basic Needs Services ........................................................................................... 2 1.2.2 Employment ........................................................................................................ 2 1.2.3 Housing ............................................................................................................... 2 1.2.4 Childcare ............................................................................................................. 3 1.2.5 Transportation ..................................................................................................... 3 1.2.6 Health ................................................................................................................. 3 1.2.7 Education ............................................................................................................ 32.0 Community Assessment .................................................................................................4 2.1 Purpose and Scope of Project ........................................................................................... 4 2.2 Methodology.................................................................................................................... 43.0 Head Start .......................................................................................................................5 3.1 What is Head Start? ......................................................................................................... 5 3.1.1 Major Components .............................................................................................. 5 3.2 Grantee Description ......................................................................................................... 6 3.2.1 Lincoln County Need........................................................................................... 84.0 Geographic Area.............................................................................................................9 4.1 Oregon Poverty Overview ................................................................................................ 9 4.1.1 Basic Family Budget ........................................................................................... 9 4.1.2 Living Wage...................................................................................................... 10 4.2 Lincoln County .............................................................................................................. 10 4.2.1. Population ......................................................................................................... 10 4.2.1.1 Race and Ethnicity .............................................................................. 11 4.2.2 Poverty .............................................................................................................. 12 4.2.3 Food .................................................................................................................. 13 4.2.4 Employment ...................................................................................................... 14 4.2.5 Children with Disabilities .................................................................................. 15 4.2.6 Housing ............................................................................................................. 17 4.2.7 Health Care ....................................................................................................... 18 4.2.7.1 Medical ............................................................................................... 20 4.2.7.2 Mental Health...................................................................................... 23 4.2.7.3. Dental Care ......................................................................................... 24 4.2.8 Child Care ......................................................................................................... 25 4.2.8.1 Child Care Assistance.......................................................................... 25 4.2.8.2 Child Development Programs (in addition to CSCHS) ......................... 26 4.2.9 Domestic Violence ............................................................................................ 26 i
  3. 3. 4.2.10 Transportation ................................................................................................... 27 4.2.10.1 Local Options ...................................................................................... 27 4.2.10.2 Regional Options ................................................................................. 275.0 Conclusions and Recommendations............................................................................. 29 5.1 Discoveries .................................................................................................................... 29 5.2 Suggestions .................................................................................................................... 29Appendix A .............................................................................................................................. 30 Successes and Partnerships ....................................................................................................... 30 Successes .................................................................................................................................. 30 Partnerships .............................................................................................................................. 31Appendix B .............................................................................................................................. 32 Working Paper – Suggested Gaps/Needs in Child Development Programs in Lincoln County as expressed by the Early Childhood Special Education Workgroup Notes .................................... 32Appendix C .............................................................................................................................. 35 Suggestions for Improving Affordable Housing Availability in Lincoln County ........................ 35Appendix D .............................................................................................................................. 36 Parent Survey and Comments.................................................................................................... 36 Parent Survey............................................................................................................................ 36 Parent Comments ...................................................................................................................... 38Appendix E .............................................................................................................................. 39 Provider Interviews ................................................................................................................... 39 Input into what works, where improvement could be made ........................................................ 39 Positive ..................................................................................................................................... 39 Needs Improvement .................................................................................................................. 39Appendix F .............................................................................................................................. 40 SWOT Analysis ........................................................................................................................ 40Appendix G ............................................................................................................................. 41 Supported Affordable Housing in Lincoln County ..................................................................... 41Appendix H ............................................................................................................................. 42 Glossary of Acronyms .............................................................................................................. 42Information Citations ............................................................................................................. 43 ii
  4. 4. List of FiguresFigure 4-1. Basic Family Budget – 2010 vs. FPL ................................................................................. 9Figure 4-2. Uninsurance Rate by Race ............................................................................................... 12Figure 4-3. Child Care Funding ......................................................................................................... 25 List of TablesTable 3-1. Early Head Start and Head Start Enrollment 2010 .............................................................. 5Table 3-2. CSCHS 2012-2013 School Year Current Comprehensive Statistics .................................... 7Table 3-3. CSCHS 2011-2012 School Year Current Comprehensive Statistics .................................... 7Table 3-4. CSCHS 2012-2013 School Year Current Comprehensive Statistics .................................... 8Table 3-5. CSCHS 2012-2013 School Year Current Comprehensive Statistics .................................... 8Table 4-1. Lincoln County Poverty Information, 2010 ...................................................................... 11Table 4-2. Population Changes 2000 to 2010 .................................................................................... 11Table 4-3. Historical Median Household Income by Race – Lincoln County ..................................... 11Table 4-4. Poverty by Age, Hispanic Origin, Race: 2011 Census – National ..................................... 12Table 4-5. Household Poverty Rate by Family Type, 2006 - 2010..................................................... 12Table 4-6. Change in Poverty Rate 2000 – 2010 Lincoln County ...................................................... 13Table 4-7. Change in Childhood (0-17) Poverty Rate in Lincoln County 2000 - 2010 ....................... 13Table 4-8. 2012 Lincoln County Hunger Facts.................................................................................. 14Table 4-9. 2012 Lincoln County Youth Hunger Facts ....................................................................... 14Table 4-10. Employment Data ............................................................................................................ 15Table 4-11. Oregon Children with Disabilities – 2011 ........................................................................ 15Table 4-12. EI/ESCE Report Card – 2010-2011 School Year .............................................................. 16Table 4-13. Rental Costs in Lincoln County School District ............................................................... 17Table 4-14. Housing Units without Plumbing, 2006 – 2010 ................................................................ 18Table 4-15A. HRSA-Generated Data for HPSA .................................................................................... 18Table 4-15B. HRSA-Generated Data for MUA/P .................................................................................. 19Table 4-16. Pediatric and Family Medical Providers Accepting Medicaid ........................................... 21Table 4-17. Institutional Medicare and Medicaid Providers, Second Quarter, 2011 ............................. 21Table 4-18. Medical Information for CSCHS Enrolled Children 2011-2012 School Year .................... 22Table 4-19. Medical Information for CSCHS Enrolled Children 2011-2012 School Year .................... 22Table 4-20. Mental Health Information for CSCHS Children 2011-2012 ............................................ 24Table 4-21. OHP Dental Providers in Lincoln County ........................................................................ 24 iii
  5. 5. Community Assessment 2012-20131.0 SUMMARY1.1 ExecutiveIn alignment with the previous two years‟ brief Community Services Consortium‟s Head Start (CSCHS)Community Assessment (CA) updates, there have been no significant demographic differences in LincolnCounty‟s basic data aside from the increase in poverty levels and continuing un-/under-employmentlevels. While these on-going statistics can be somewhat attributed to the continuing recession, theCounty‟s service-based, lower-wage industry, and a lack of affordable housing, continue to beproblematic barriers to raising the standard of living and thus lowering poverty and unemployment levels.There are, however, developments in play since the 2010 triennial assessment that are encouraging: Oregon‟s federally supported pilot for health care reform (including Healthy Kids and potential for influx of medical providers) Coordinated Care Organizations (CCO), medical care homes, expanded Medicaid services/client base Restructure of the Commissions on Children and Families into Early Learning Hubs (negative and/or positive effects on the Head Start program has yet to be realized) After a highly competitive process, Lincoln County secured relocation of the west coast‟s National Oceanographic and Atmospheric Administration (NOAA) Marine Operations Center-Pacific on the south shore of Yaquina Bay in Newport; this renowned research organization is expected to provide a $20 million dollar per-year boost to the local economy.In review of overall performance and perception of the CSCHS, it is noted that improvement of servicesto its children and families coupled with its reputation as a model of partnership in early childhoodlearning has increased significantly when compared to the 2010-2011 CA. Interviews and collaborativemeetings with community partners reflects the positive appreciation as do the increase in CLASS scoresand creation of solid infrastructure, including comprehensive policies and procedures and an ongoingmonitoring tool. Staff pursuit of higher education and attainment of degrees and certifications continues,and notably all program staff have developed educational plans.Additionally, parent satisfaction remains high both with program and ancillary services, and staff havehigh morale and demonstrate sustainable commitment to excellence as evidenced by discussion with theCSCHS Director and various administrative and program staff. CSC itself is a continuing source ofprogram and family support through internal and partnered community-based referrals. It is alsoimportant to note that eight of twenty-five CSCHS staff members began as Head Start parents and shouldbe lauded both for importance to programmatic success and in reflecting positive and sustainable changesthis systemic program can engender to those in isolation and poverty.The CSCHS Health Services Advisory Committee (HSAC) has proved itself as a vital component of theresources in the Program‟s collaborative toolbox. The meetings occur quarterly and are substantive, andthe cross-section of involved disciplines reveals a strong community basis of support for the health andwell-being of the children and families engaged in CSCHS. The outcome measures and statistics reportedmonthly depict a well-monitored and developed system of assisting children and families in accessingneeded physical and dental health services. This aspect of the program is one of the strongest in spite ofdifficulties operating a thriving program in a Health Professional Shortage Area (HPSA) as defined by theDepartment of Health and Human Services‟ Health Resources and Services Administration (HRSA).The monthly Eligibility, Recruitment, Selection, Enrollment and Attendance (ERSEA) reports I reviewedshow the Newport program site to contain the largest waitlist of the three CSCHS sites. While Toledohistorically has been considered as suffering the highest levels of poverty in the County, it is Newport thatnow counts the highest level of poverty. The Newport site, according to the CSCHS Director, is showingincreasing need for service expansion; Lincoln City continues to have the highest enrollment. Lastly,South County (Waldport and Yachats) continues to show great interest in containing its own Head Start 1
  6. 6. site, and CSCHS has shared conversation with community members, electeds, and partners to talk aboutthe need and resources (human and capital) that would be required for such expansion. Currently there areno sustainable expansion funds available.Finally, and perhaps most importantly, community information outlined in this report was of no surpriseto the CSCHS Director, and she continues to be responsive in addressing any specific concerns expressedto her from program families and/or community at large. With a variety of changes anticipated at the Statelevel, funding and/or broad organizational governance, there continues to be considerable opportunitythrough forums and other public meetings in Lincoln County and elsewhere for partnership-building andother collaborative efforts. The next years will be of critical significance to CSCHS‟ longevity andstructure (as well as other Oregon Head Start programs), and annual CA updates will track changes asthey manifest.1.2 DataBased on information obtained through written survey; provider, Director, staff interviews; and availablestatistical, historical and experiential data; the following areas have been identified as priority needs forlow-income residents with pre-kindergarten children in Lincoln County, Oregon:1.2.1 Basic Needs ServicesBasic needs services continue to be a priority. Respondents reported concerns about food, shelter, utility,and transportation. The level of these needs demonstrates the continued importance of mobilizing bothpublic and private entities to ensure that sufficient affordable housing, basic needs, and other community-based resources are available. Additionally, helping families to address basic needs is critical forstabilization and prevention of episodic and/or long-term chronic homelessness. CSCHS staff, throughcase management and advocacy, works directly with families to address any specific needs and concernsas they arise and provide referrals as appropriate.1.2.2 EmploymentLincoln County residents continue to report employment and economic self-sufficiency as a significantneed. These reports are not surprising given the surge in the unemployment rate which reached 13% inOregon generally and 9.5% in Lincoln County specifically in 2011 (was 8.5% in November 2012).The economic stability needs of unemployed and underemployed Lincoln County residents can bestrengthened by helping link individuals to the many supports in the community including basic needs,information about accessing state/other benefits, employment and training, and financial educationsupports. Life Skills education, including budgeting and household management assistance, are alsoimportant steps that should be taken to enhance work toward self-sufficiency.1.2.3 HousingThe Department of Housing and Urban Development (HUD) estimates that housing costs should reflect30% of a family‟s income1. With affordable housing at a premium in Lincoln County, the ability offamilies to afford a home is slipping further out of reach. The significant numbers of individuals reportinga concern with housing issues clearly underscores the need for a concentrated effort to alleviate the strainon families caused by the high cost of decent, safe housing2. The surge in unemployment and continuinghigh foreclosure rates has placed additional strain on low-income individuals and families, which alsocontributes to an increased risk in homelessness.Workforce housing (including affordable housing for lower-income households) is increasingly indemand and unavailable as any remaining available housing and land are being purchased and developed1 www.hud.gov.2 See Table 4-13 for cost of housing in Lincoln County. 2
  7. 7. as vacation homes. This housing type rents in off-seasons for greater amounts which, effectively, removeany decent affordable housing from the market; what is left in affordability isn‟t always decent or safe.1.2.4 ChildcareAffordable child care remains a significant need in Lincoln County, and greater numbers of working low-income families indicate need for financial assistance with child care. Additionally, there is need for safe,affordable, and flexible day care to aid a family‟s employment searches. Although employment-relatedday care (ERDC) is available to low-income families through Oregon Department of Human Services, thelegislatively approved caseload and funding opportunities don‟t adequately meet the need.1.2.5 TransportationTransportation continues to be an issue especially for lower-income residents. While the greaterpercentage of CSCHS families report ownership of a running vehicle which can travel at least 50 miles,cost of gas and car repairs often bar use. CSCHS makes every effort to assist families with identifiedtransportation issues in connecting with other agencies and/or transportation services which might assist.CSCHS families are encouraged to build carpool and other transportation-sharing options as well.Ultimately, the need for reliable, flexible, and affordable public transportation presents as a contributingbarrier to economic self-sufficiency and an improved quality of life.1.2.6 HealthAs previously written, the entirety of Lincoln County is considered a Health Professional Shortage Area(HPSA) and additionally lists parts of the county as Medically Underserved Areas/Populations (MUA/P).This designation very much supports the reality that shortages exist in all aspects of health care in LincolnCounty, whether the need is in physical, mental, or dental health services. Most importantly, this medicalprofessional shortage is doubly concerning for children and families who are participants of Oregon‟sMedicaid program, Oregon Health Plan (OHP), as there are even fewer of the existing medicalprofessionals who accept this insurance option. Pediatric specialists who accept OHP are few, and in thecase of mental health professionals and dentists, there are none listed directly in Lincoln County in theOHP provider network.While there are regional transportation options available – free to obtain medical services in adjoiningcounties through OHP – the reality is that a greater provider network locally is a severe need and deserves– along with housing – greater community focus.1.2.7 EducationWith the fourth-lowest high school graduation rate as a state3 (National is 78%, Oregon is 66%, LincolnCounty is 65%), there clearly remains a solid need to address educational challenges. Survey respondentsreport the need for enhanced education programs including improved literacy education, English as aSecond Language (ESL) support, and GED preparation, which clearly demonstrates the need to continueto develop and maintain comprehensive educational supports for children and adults alike. Throughimproved educational outreach and programming, high school drop-out rates can be reduced and theability of residents to maintain longer-term economic self-sufficiency increased.3 Ed.gov; “Regulatory Adjusted Cohort Graduation Rate, All Students: 2010-11”. 3
  8. 8. 2.0 COMMUNITY ASSESSMENT2.1 Purpose and Scope of ProjectThe purpose of this report is to present the results of a Community Assessment (CA) for CSCHS. A CA isthe collection and analysis of information on the needs and characteristics of Head Start (HS) eligiblechildren and families in a grantee‟s service area. Further, it identifies issues and trends that impactfamilies with young children and programs and community resources available to meet the family needs.A completed CA is used to guide program planning and evaluation decisions.Every three years the National Head Start Program, through its Federal funder, Department of Health andHuman Services (HHS), requires all Head Start programs to conduct a full or extensive CA, and 2013 isCSCHS‟s full report year (updates will be completed in each of the two years following the full CA).There are six content areas that must be included in a CA (labeled A1-A6):1. A1: The estimated number, geographic location, and racial/ethnic composition of Head Start children2. A2: Other child development programs that serve Head Start eligible children and the approximate number served3. A3: The estimated number of children four years old or younger with disabilities and services provided to these children4. A4: Data regarding the education, health, nutrition and social service needs of Head Start eligible children and their families5. A5: The education, health, nutrition and social service needs of Head Start eligible children and their families as defined by families of Head Start families and by community institutions that serve young children6. A6: Community resources that could be used to address the needs of Head Start eligible children and their families.To most accurately and contextually present the requisite information, this report is organized into thefollowing sections: Summary  Geographic Area Community Assessment  Conclusions and Suggestions Head Start  Appendixes2.2 MethodologyInformation contained in this report was obtained from a variety of sources including written documents,personal interviews, and the writer‟s own knowledge and understanding. Chief among the researchreports and tools accessed to determine specific demographics were: U.S. Census Bureau 2010 data andAmerican Community Survey; Children First for Oregon; Children‟s Defense Fund; Oregon Head Start‟sProgram Information Report (PIR) summarized for Oregon HS programs/grantees; CSCHS internaldocuments (e.g., 2011 PIR, newsletters, budget, and Governing Board presentation materials); andinformation obtained through website review of various Lincoln County service providers and studies(e.g., Healthy Start, WIC, etc., 10-Year Plan to End Homelessness, Commission on Children andFamilies‟ Assessment, etc.).An informational survey was also designed by this writer and subsequently completed by 56% of thecurrent CSCHS parents of children participating at all three classroom sites. Further, person-to-personinterviews were conducted and/or phone conversations were held with staff members from LincolnCommission on Children and Families; Olalla Center; Lincoln County Commissioners; Lincoln CountyHealth Department; Linn, Benton and Lincoln Education Service District; and Lincoln County schooldistrict. 4
  9. 9. 3.0 HEAD START3.1 What is Head Start?Head Start is a national program which provides comprehensive developmental services for Americaslow-income, pre-school-aged children (three to five years) and social services and supports for theirfamilies. Approximately 1,400 community-based non-profit organizations and school systems nationallydevelop unique and innovative programs to meet specific needs.Head Start began in 1965 in the Office of Economic Opportunity and is now administered by theAdministration for Children and Families. In FY2012, $7,9 billion4 was available for Head Start servicesnationally and awarded to local public or private non-profit agencies; 20% of the total cost of a Head Startprogram must be contributed by the community. Head Start programs operate in all 50 states, the Districtof Columbia, Puerto Rico, and the U.S. territories.3.1.1 Major ComponentsHead Start provides diverse services to meet the goals of the following four components: Education – Head Starts educational program is designed to meet the needs of each child, the community served, and its ethnic and cultural characteristics. Every child receives a variety of learning experiences to foster school readiness by enhancing intellectual, social, and emotional growth. Health – Head Start emphasizes the importance of early identification of health problems. Every child is involved in a comprehensive health program which includes immunizations, medical, dental, mental health, and nutritional services. Parent Involvement – An essential part of Head Start is the involvement of parents, as they are their children‟s primary teachers and advocates. Parent engagement includes parent education, program planning, and operating activities. Many parents serve as members of policy councils and committees and have a collaborative voice in administrative and managerial decisions. Participation in classes and workshops on child development and staff visits to the home encourages parents to learn about the needs of their children and educational activities that can take place at home as well as information- sharing with the teacher about their child‟s development. Social Services – Specific services are geared to each family after needs are determined and could include community outreach; referrals; family need assessments; recruitment and enrollment of children; and emergency assistance and/or crisis intervention.Only 3% percent of eligible children are able to secure spots in Head Start due to limited funding (seeTable 3-1 for enrollment information about Head Start Preschool)5. Table 3-1. Early Head Start and Head Start Enrollment 20104 http://www.acf.hhs.gov/programs/ohs/news/fy-2012-head-start-funding-increase-0 (HHS Administration for Children &Families); funding level represents an increase of approximately $409 million over the FY 2011 appropriation level.5 National Women’s Law Center. 2011. “Head Start: Supporting Success for Children and Families”;http://www.nwlc.org/sites/default/files/pdfs/head_start_fact_sheet_2011.pdf. 5
  10. 10. The annual cost of center-based pre-school for a four-year old is more than the annual in-state tuition at apublic four-year college in 26 states and the District of Columbia 6, and 30% of children in poverty scorevery low on early reading skills when compared to only 7% percent of children from moderate- or high-income families 7. Without high-quality early childhood intervention, an at-risk child is: 25% more likely to drop out of school 40% more likely to become a teen parent 50% more likely to be placed in special education 60% more likely never to attend college 70% more likely to be arrested for a violent crime 8.3.2 Grantee DescriptionHead Start is one of the nation‟s first child development programs to implement a two-generationapproach, working with both children and their low-income parents as primary teachers of their ownchildren. Teachers are also „advocates‟ for the children and their families. In 2012-2013, CSCHS willprovide federal- and state-funded preschool services to 160 Lincoln County children and their familiesthrough classroom sites in Toledo, Newport, and Lincoln City, though the actual numbers served mayvary depending upon funding changes.CSC began serving Head Start children and families of Lincoln County in August 1996. The programcurrently provides services to 160 three and four year old children from 155 families. The 160 childrenare funded as follows: 102 are federal Head Start funded and 58 are Oregon Pre-Kindergarten funded.Children receive center-based services where they are offered 3.5 hours of classroom service four days aweek and four teacher conferences throughout the year, two of which are home visits. Center-basedclasses are held in the cities of Lincoln City, Newport, and Toledo. The most recently opened location isNewport in May 2009. For program year 2011-2012, CSCHS‟s total budget was $1,436,585 and included17.83 full-time equivalent staff.CSCHS supports and understands that:Low-income children who are hungry, have never been to the doctor, who have few or no books at home,who are more likely to view violence have different needs than their middle- or upper-income peers andcan benefit from the program. Eligible children benefit from intensive, targeted, community-basedservices resulting in greater school and life success because of Head Start (see Table 3-2). Research indicates 9 that Head Start generates long-term improvements in important outcomes such as schooling attainment, earnings, and crime reduction.CSCHS‟s programming foundation is based on parent and service provider partnerships and, with theassistance of on-going and new community connections, meets its measureable outcomes through: Supporting at-risk Lincoln County families in achieving successes and self-sufficiency with dignity Providing experiences for enrolled pre-school children to grow socially, emotionally, physically, and mentally Providing every parent with opportunities to participate in program shared-decision-making Connecting families to necessary community services and other opportunities geared toward stabilization.6“ Double Jeopardy: How Third-Grade Reading Skills and Poverty Influence High School Graduation”; The Annie E, Casey Foundation; Hernandez, Donald J.; April 2011.7 Brookings Institution. 2012. “Starting School at a Disadvantage: The School Readiness of Poor Children.” http://www.brookings.edu/~/media/research/files/papers/2012/3/19%20school%20disadvantage%20isaacs/0319_school_disad vantage_isaacs.pdf.8 Center for American Progress. 2012. “Increasing the Effectiveness and Efficiency of Existing Public Investments in Early Childhood Education: Recommendations to Boost Program Outcomes and Efficiency.” http://www.americanprogress.org/issues/2012/06/pdf/earlychildhood.pdf.9 “Longer-Term Effects of Head Start” (NEBR Working Paper No. 8054); Eliana Garces, Duncan Thomas, and Janet Currie; 2001. 6
  11. 11. Table 3-2. CSCHS 2012-2013 School Year Current Comprehensive Statistics Health Oct Nov Dec Statistics 2012 2012 2012 # of enrolled children with up-to-date/all possible immunizations to date 137 142 142 # of enrolled children on schedule of preventative/primary health care (up-to-date physical exam) 105 120 123 # of enrolled children with ongoing source of continuous, accessible health care 152 156 155 (Medical Home) # of enrolled children completing professional dental exams 89 102 108 # of enrolled children with continuous, accessible dental care provided by a dentist (dental home) 151 152 151CSCHS promotes child school-readiness and family self-sufficiency through comprehensive andintensive services including early childhood education, health and social services, nutritious meals, andparent partnership and involvement. Through 11 primary domains of learning10 (aligned with the HeadStart Child Development and Early Learning Framework which is in the process of being adopted by theOregon Department of Education as the early learning standards for children ages 3-5) and an overallstructure for school-readiness, children‟s progress is measured, adjusted, and reviewed with outcomemeasurement tools including Galileo Pre-K Online assessment and Classroom Assessment ScoringSystem (CLASS).Children are expected to make a 50-point gain in skills (from first assessment to final rating) over theschool year for each of the learning domains. CSCHS Developmental Level (DL) scores exceededexpected gains in each domain; average point gain was 131 as evidenced by the following Table 3-3. Table 3-3. CSCHS 2011-2012 School Year Current Comprehensive Statistics CSCHS Developmental Level (DL) scores Beginning of Point Gain Percentage Developmental Domain Year End of Year 50 Expected Increase Approaches to Learning 467 609 142 30% Creative Arts 495 661 166 34% Early Math 463 587 124 27% English Language Acquisition 473 555 82 17% Language 430 574 144 33% Literacy 444 579 135 30% Logic and Reasoning 508 630 122 24% Nature and Science 438 586 148 34% Physical Development & Health 449 576 127 28% Social and Emotional Development 428 558 130 30% Social Studies 477 597 120 25%10 Physical Development & Health, Social & Emotional Development , Approaches to Learning , Language Development, Literacy knowledge & Skills, Mathematics knowledge & Skills, Science knowledge & Skills, Creative Arts Expression, Logic & Reasoning, Social Studies knowledge & Skills, English Language Development (for dual-language learners). 7
  12. 12. 3.2.1 Lincoln County NeedCSCHS is a vital program that supports the enrolled children, families, and connected communitieswithin Lincoln County. In the 17 years the Program has been housed within CSCHS, the numbers servedper year has increased from 97 to 160 through award of competitive grants both federal and state (seeTable 3-4). In 2011, the Program counted 86 eligible children/families on the waiting list (see Table 3-5).The unfortunate truth is that: Preschool children are the most likely age group to live in poverty Oregon is consistently included in national statistics as posting some of the highest unemployment and food insecurity rates Lincoln County has one of Oregon‟s highest domestic violence rates per capita and the second highest county child abuse rate (nearly twice the state‟s average) Pre-school children need to have a safe space in which to learn developmentally appropriate educational and social-emotional skills and receive support to ensure school readiness Table 3-4. CSCHS 2012-2013 School Year Current Comprehensive Statistics Enrollment, Attendance, and Meal & Snack Report Month Enrollment Attendance Breakfast/Snack Lunch Total MealsSeptember 2012 160 91.22% 1,410 1,417 2,827October 2012 160 87.08% 2,379 2,418 4,797November 2012 160 82.57% 2,152 2,164 4,316December 2012 160 86.69% 1,446 1,468 2,914 Totals 86.89% 7,387 7,467 14,854 Table 3-5. CSCHS 2012-2013 School Year Current Comprehensive Statistics Wait List Monthly Count Poverty Income 130% Income Over Income Total Applications Site T N LC T N LC T N LC T N LC Total ProgramAs of 10/25/2012 8 12 4 0 3 2 5 14 4 13 29 10 52As of 11/5/2012 7 14 8 1 3 2 5 14 4 14 31 13 58As of 12/5/2012 7 14 9 1 4 2 5 14 4 13 32 15 60As of 1/4/2013 8 14 3 1 4 2 5 1 5 14 32 10 56 8
  13. 13. 4.0 GEOGRAPHIC AREA4.1 Oregon Poverty OverviewThe Federal Poverty Line (FPL) is based on a 1955 household survey and, though updated annually,relies on out-of-date assumptions. It fails to address the impact of today‟s high housing, health, and childcare costs or even work-related expenses. The resulting “official” poverty rates seriously underestimatethe “real” poverty:FPL for a family of four = $23,050 (2012)Full time job at Oregon minimum wage = $18,304 (2012)Full time job at Federal minimum wage = $15,080 (2012)Basic Family Budget for a family of four in Oregon for 2012 = $50,304 (see graph below)Though Oregon‟s minimum wage increased January 1, 2013, four-person households with two full-timeworkers earning minimum wage (combined $37,232) is still less than 200% of the FPL. While manyOregonians did get the „boost‟ to help make ends meet, two incomes is a comfort few households have.74% of households surveyed in a 2012 Oregon Food Bank project reported incomes below 100% of FPL.4.1.1 Basic Family BudgetUsing the Economic Policy Institute‟s (EPI) “basic family budget” calculator as a model, the familybudget illustrated above was fine-tuned using more localized sources for some of the figures. EPI‟s studywas published in 2007 and adjusted for 2012 inflation using the Consumer Price Index calculator (seeFigure 4-1). The calculations by EPI, a non-profit, non-partisan think tank, also include such essentials ashousing, food, child care, and health insurance. For a typical Oregon family, a basic family budget rangesfrom 197% to 231% of the Federal poverty line11. More than 1.4 million Oregonians, about one-third, tryto survive with incomes below 200% of the FPL ($46,100 for a family of four)12. Figure 4-1. Basic Family Budget – 2010 vs. FPL11 Economic Policy Institute, Basic Family Budget Calculator,http://www.epi.org/budget_form.cfm?CFID=3447799&CFTOKEN=41949049.12 U.S. Census, American Community Survey 2011;http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml? pid=ACS_11_1YR_S1701&prodType=table. 9
  14. 14. 4.1.2 Living WageA living wage is one that allows families to meet their basic needs without resorting to public assistanceand one which provides some ability to deal with emergencies and plan ahead.In 2010, the living wage for a single adult in Oregon was $15.20/ hour. Of all job openings in Oregon in2010, 52% paid less than 15.20/hour; for job openings that pay at least $15.20 per hour, there are at least14 seekers on average134.2 Lincoln CountyLincoln County is primarily rural, and Newport serves asthe County seat. It has a total area of 1,194 square milesabout the size of Rhode Island. In terms of boundaries,the county is bordered by the Pacific Ocean to the west,Tillamook County to the north, Polk County to thenortheast, Benton County to the southeast, and LaneCounty to the south. Lincoln County has seven uniqueincorporated communities: Depoe Bay, Lincoln City,Newport, Siletz, Toledo, Waldport, and Yachats.The countys economy is based on services, tourism, trade, commercial fishing, food processing, paperprocessing, and wood and lumber products. The economy is also supported by a large and increasingnumber of retirees.According to the 2010 US Census, Lincoln County families experience higher levels of poverty at 11.6%as compared to the statewide rate of 11.0%.Children are also greatly impacted by the recent poverty trends, counting approximately 39% of allchildren in Oregon living in families with low incomes who cannot meet their basic needs for food andshelter. According to Patricia Post‟s report14, some economists estimate that persistent childhood povertycosts the United States roughly $500 billion a year by way of lost productivity, school drop-outs, crime,and the growing numbers enrolled in nutrition and public assistance programs. Solving poverty is beyondthe scope of this needs assessment, but it can point the way to a variety of near-term and longer-termapproaches to mitigate its most serious impacts. Every forward step taken as a co-productive communitywill bring multiple benefits.According to Jeffery Bartash of MarketWatch.com, even those traditionally living above the poverty levelsaw their earning power decline, with 2011 median income falling 2.9% from 2009, the second sharpestdecline on record. Some estimates indicate that more than 55 million people in the United States will needassistance to meet their basic needs in the coming years.The State of Oregon is 13th in the nation in economic recovery and, as we know, economic upheavalshave a disproportionately negative impact on lower-income families as they enter the unemploymentlines, see a reduction in work hours and wages, and fight rising interest rates on credit debt, all of whichhave the greatest impact on those who can afford it the least.4.2.1. Population2010 poverty estimates show a total of 7,734 persons living below the poverty rate in Lincoln Countywith more than one in ten (17%) of all families living below the poverty line (FPL)15 (see Table 4-1).13 2010 Job Gap Study http://nwfco.org/wp-content/uploads/2010/12/2010-1209_2010-Job-Gap.pdf.14 “Hard to Reach: Rural Homelessness and Health Care,” http://www.nhchc.org/wp- content/uploads/2012/02/October2001HealingHands.pdf.15 U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2010. 10
  15. 15. Table 4-1. Lincoln County Poverty Information, 2010 All Ages Age 0-17 Age 5-17 Number Poverty Number of Poverty Number of Poverty Geographic Area of Persons Rate Persons Rate Persons RateLincoln County, Oregon 7,734 17.0 2,325 30.1 1,538 28.3Oregon 596,649 15.8 184,511 21.7 119,412 19.5United States 46,215,956 15.3 15,749,129 21.6 10,484,513 19.8Table 4-2 shows overall population changes in the United States, Oregon, and Lincoln County from 2000to the 2010 census. Table 4-2. Population Changes 2000 to 2010 Census 2000 Census 2010 % Geographic Area Population Population Population Change ChangeLincoln County 44,479 46,034 1,555 3.50Oregon 3,421,437 3,831,074 409,637 11.97United States 281,424,602 312,471,327 31,046,725 11.034.2.1.1 Race and EthnicityCurrently, the Hispanic16 population in Oregon is counted at 12%, while in Lincoln County thispopulation group is counted at 8.1%, an increase of 0.9% over the 7.2% listed in the 2010 communityneeds assessment report. The top needs identified for the Hispanic population via the CSHS ParentSurvey (see Appendix D) are employment, health care, legal assistance, ESL training, transportation (wayto obtain legal licenses), and affordable housing.Table 4-3 shows median income of Lincoln County‟s Hispanic population, Table 4-4 shows childhoodpoverty, and Figure 4-2 shows the lack of health insurance in Oregon by race. See the section on HealthCare (page 18) for information on Oregon‟s health care reform, coordinated care organizations and theHealthy Kids initiative, all of which intends to increase the numbers of children covered by healthinsurance regardless of race.CSCHS continues to respond to the needs of Spanish-speaking families by increasing interpreter hours,making available bi-lingual forms, and hiring bi-lingual staff and engaging parent volunteers. Table 4-3. Historical Median Household Income by Race – Lincoln County17 Lincoln County Oregon 10-Year U.S. 10-Year Race 2006-2010 2005-2009 2000 Average Average Hispanic 30,097 36,167 33,500 35,294 38,718 White 40,189 38,315 32,956 47,177 51,40716 For purposes of U.S. Census and American Community Survey data collection, the ethnic group Hispanic also includes anynumber of Latino populations.17 American Community Survey 2000-2010 11
  16. 16. Table 4-4. Poverty by Age, Hispanic Origin, Race: 2011 Census – National18 (Numbers in thousands) Hispanic Origin and Race20 Non-HispanicAge and Total Hispanic Total White alone All other races Poverty Status19 Number Percent Number Percent Number Percent Number Percent Number PercentUnder 18 74,494 100.0 17,435 100.0 57,059 100.0 40,494 100.0 16,565 100.0yearsBelow 16,401 22.0 6,110 35.0 10,291 18.0 5,002 12.4 5,289 31.9povertyAt/above 58,093 78.0 11,325 65.0 46,768 82.0 35,492 87.6 11,276 68.1poverty Figure 4-2. Uninsurance Rate by Race Oregon Health Plan 201114.2.2 PovertyTable 4-5 shows percentage of Lincoln County households in poverty by household type. In 2010, it isestimated that 11.67% of all households were living in poverty within the County compared to thenational average of 10.08%. Of the households in poverty, female headed households represented 40.66%of all households in poverty compared to 8.15% and 51.20% of households headed by males and marriedcouples, respectively. Table 4-5. Household Poverty Rate by Family Type, 2006 - 2010 Geographic Area All Types Married Couples Male Householder Female Householder Lincoln County 11.67 7.30 21.33 34.70 Oregon 9.60 4.81 16.49 30.27 United States 10.08 4.90 14.58 28.8618 U.S. Census, American Community Survey 2011;http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml? pid=ACS_11_1YR_S1701&prodType=table.19 Poverty statistics exclude unrelated individuals under 15.20 Hispanic refers to people whose origin is Mexican, Puerto Rican, Cuban, Spanish-speaking Central or South Americancountries, or other Hispanic/Latino, regardless of race. 12
  17. 17. Poverty rate change in Lincoln County 2000 to 2010 is shown in Table 4-6. According to the U.S.Census, the poverty rate for the County increased by 3.1%. Table 4-6. Change in Poverty Rate 2000 – 2010 Lincoln County Change in Poverty Geographic Persons in Poverty Rate Persons in Poverty Rate Area Poverty 2000 2000 Poverty 2010 Rate 2010 2000 – 2010Lincoln County 6,070 13.9 7,734 17.0 3.1Oregon 361,280 10.6 596,649 15.8 5.2United States 31,581,086 11.3 46,215,956 15.3 4.0The poverty rate change for all children in Lincoln County from 2000 to 2010 is shown in Table 4-7. Inthis case, the childhood poverty rate for the County increased by 7.5% compared to an Oregon increase of6.6% and a national increase of 5.4%. Table 4-7. Change in Childhood (0-17) Poverty Rate in Lincoln County 2000 - 2010 Geographic Children in Poverty Rate Children in Poverty Rate Change in Poverty Area Poverty 2000 2000 Poverty 2010 2010 Rate 2000 – 2010Lincoln County 2,064 22.6 2,325 30.1 7.5Oregon 127,544 15.1 184,511 21.7 6.6United States 11,587,118 16.2 15,749,129 21.6 5.44.2.3 FoodAccording to 2012 Oregon Food Bank report21, Oregon has higher-than-national-average rates for hungerand food insecurity (currently 17.5% in Lincoln County). More than half (61%) of Lincoln Countystudents (k-12) qualify for free or reduced lunch, and more than 400 students in the school district areconsidered homeless (defined as living with relatives or friends, awaiting foster care, or living in anemergency shelter, motel, campground, car or park).Oregon Food Bank VOICES 2009 reported that families are making food choices based on cost or qualitywhen knowing that choosing healthy foods may mean not having enough food to last the month. On astate level, roughly one in six Oregonians receive food stamps (see Table 4-8). This number is the highestin the history of the state program and well above the national average. The average food stamp benefit is$176 a month or $1.96/meal, less than the $2.50/child Head Start is reimbursed. Food stamps are tied tomatch inflation, but in 2008 the drastic spike in prices kept the annual increase from keeping pace withprices. Sixty-seven percent (67%) of food stamp recipients report that benefits last less than two weeks.Access to food is difficult in pockets through the County. Residents in Eddyville, for example, must drivemore than 25 miles leaving those without transportation or mobility vulnerable22. Rural grocery storeshave become more or less convenience stores, offering little in the way of fresh produce or reallynutritious food. This is alarming considering many rural residents depend on these stores.21 “Profiles of Hunger and Poverty in Oregon, 2012 Hunger Factors Assessment”; Oregon Food Bank.22 A person is considered „food insecure‟ if she/he lives more than 10 miles or more from a grocery store. 13
  18. 18. Each month, too many Lincoln County residents rely on emergency food assistance as a necessity tomake ends meet. Children are particularly vulnerable with before- and after-school program cuts, as theseopportunities are often their most consistent source of food. Programs – such as the Backpack for Kidsprogram23 – rely on a precarious structure of volunteers and community donations. The East CountyBackpack program serves 56 students in Toledo and Siletz with 30 to 40 more kids in need but no fundingfor them to participate. Fortunately Lincoln City and Newport sites have backpack programs for their highneed families and it is anticipated that Toledo will also have one in 2013 (see Table 4-9 for youth hungerfacts).Poverty and low wages are the underlying causes for food insecurity in the region. Highunderemployment and unemployment can be blamed to a degree, but living costs for basic monthlyexpenses including high rent, child care costs, and gas (currently hovering near $3.80/gallon) make eventhose who work full-time at minimum wage food insecure. Table 4-8. 2012 Lincoln County Hunger Facts Food Insecurity 17.5% SNAP Users 18.9% SNAP $ into the County $13 Million SNAP Participation Rate 71% Food Boxes 13,580 Minimum Wage Hours for a 1 Bdrm Apartment 56 hours/week Cost per Meal $2,84 County Health Outcomes 27th Table 4-9. 2012 Lincoln County Youth Hunger Facts Free/Reduced-Meal Eligibility 67.4% Free/Reduced-Meal Participation Rate 62.6% Summer Meals (served 2010) 15.144 Backpack Programs 3 Homeless Students 471 Childhood Obesity 28.9%4.2.4 EmploymentLabor force, employment, and unemployment data for Lincoln County is provided in Table 4-10. InNovember 2011, the non-adjusted unemployment rate was 9.5%. October 2012 saw the rate drop to 8.6%,and November 2012‟s rate was lower again at 8.8%. Nearly one third (29%) of the Lincoln County workforce is employed in the leisure and hospitality industry, the most common employment for non-skilledlabor in the county. The average hourly wage for this industry is minimum wage, $8.80/hour 24, or roughly$18,304 annually25 if the employee works full time.23 See collaborative partner successes in Appendix A.24 Oregon minimum wage rose to $8.95/hour January 1, 2013.25 Oregon employment Department Covered Employment and Wages, Q3 2012. 14
  19. 19. Table 4-10. Employment DataAccording to WorkSource Oregon‟s Labor Force and Unemployment estimates26 – November 2012 – thecounty labor force consisted of 22,342 people. Employment levels tend to fluctuate throughout the yeardue to dependence on seasonal employment activities like tourism, food processing, and fishing, and theunderemployment level includes the unemployed and also people who work part time but would like towork full time. Rather than hiring new employees when the economy improves, companies probably willmove these employees to full time, meaning an unchanged jobless rate. Therefore, unfortunately, there isa direct correlation between unemployment and poverty; as unemployment increases so does poverty. Allthis serves as important context information when examining HS eligible children and families in LincolnCounty.It is evident that economic hardship exists in all areas of the County and that job losses continue throughall industries. However, it is interesting to note that health care and government job losses are new trends,with 11.8% and 2.3% labor decreases, respectively. Additionally, the population is slow to grow with thebaby-boom generation aging into retirement and the Latino population is the 2nd highest impoverishedpopulation group. Ultimately, the CSCHS wait list demographics is an indicator of where services areneeded and confirms current service locations are appropriately placed throughout the County.4.2.5 Children with DisabilitiesPartnership with Early Childhood Special Education (ECSE) is a very successful collaboration in LincolnCounty (see Appendix E for Provider Interviews). By December of 2012, 20 CSCHS children, or 13% oftotal enrollment, had been identified with special needs and appropriately referred to ECSE for furtherevaluation and services. The partnership is important as it serves a vulnerable and high-need population,and addresses the necessity of preparing these children for mainstream school readiness. According toOregon Department of Human Services 27, 108 children in Lincoln County received on-going casemanagement services in 2011.Table 4-11 shows numbers of Oregon children with disabilities divided by urban and rural locations. Table 4-11. Oregon Children with Disabilities – 2011The Oregon Department of Education contracts with nine Education Service Districts (ESDs) across thestate to provide early intervention/early childhood special education (EI/ECSE) services in 33 localprograms. This system includes Part C early intervention (EI) for children birth to age three and Part B26 Oregon Labor Market Information System; http://www.qualityinfo.org/olmisj/DoQuery?itemid=00004804.27 DHS Developmental Disabilities Data Book – 2011. 15
  20. 20. early childhood special education (ECSE) for children age three to kindergarten age, which is age five inOregon. Children who are age five by September 1 are eligible for public school with special educationservices provided by the local school district.In Lincoln County, the Linn-Benton-Lincoln ESD in Albany administers this opportunity, and the LincolnCounty School district provides an in-house administrator who reviews referred children against thesedisability eligibility criteria and disorders: communications; autism spectrum; hearing, visual, orthopedicand other impairments; specific learning disability; emotional disturbance; intellectual disability;deafness; blindness; traumatic brain injury; early intervention. Table 4-12 demonstrates the effectivenessof specific EI/ECSE measures in preparing children for school-readiness in Lincoln County28. The fullReport Card and additional measures can be accessed via the web link in Footnote 34. Table 4-12. EI/ESCE Report Card – 2010-2011 School Year Improved Outcomes in Positive State Program Social-Emotional Skills Target Infants and toddlers who entered or exited early intervention below age 92.3% 80.9% expectations and substantially increased their rate of growth by age 3 or when they exited the program Infants and toddlers who were functioning within age expectations by age 3 or 71.4% 59.1% when they exited the program Preschool children who entered the preschool program below age expectations 86.4% 74.3% and substantially increased their rate of growth by age 6 or when they exited the program Preschool children who were functioning within age expectations by age 6 or 26.9% 32.5% when they exited the program Improved Acquisition and Use of State Program Knowledge and Skills Target Infants and toddlers who entered or exited early intervention below age 85.7% 63.7% expectations and substantially increased their rate of growth by age 3 or when they exited the program Infants and toddlers who were functioning within age expectations by age 3 or <5.0% 7.3% when they exited the program Preschool children who entered the preschool program below age expectations 61.9% 60.5% and substantially increased their rate of growth by age 6 or when they exited the program Preschool children who were functioning within age expectations by age 6 or 19.2% 23.6% when they exited the program Improved Use of Appropriate State Program Behaviors to Meet Needs Target Infants and toddlers who entered or exited early intervention below age 76.9% 64.4% expectations and substantially increased their rate of growth by age 3 or when they exited the program Infants and toddlers who were functioning within age expectations by age 3 or 7.1% 18.1% when they exited the program Preschool children who entered the preschool program below age expectations 57.1% 44.8% and substantially increased their rate of growth by age 6 or when they exited the program Preschool children who were functioning within age expectations by age 6 or 23.1% 31.7% when they exited the program28 Oregon Department of Education; http://www.ode.state.or.us/data/reportcard/sped/SPEDpdfs/12/12-SpEdReportCard-Conf-EC21.pdf. 16
  21. 21. 4.2.6 HousingThe combination of high demand, a limited base of buildable land, and low wages have worked in concertto create a workforce housing crisis in Lincoln County beyond the continuing and growing need for clean,safe, and affordable low-income housing. Even the burst of the housing bubble that helped precipitate therecession did not reverse the fact that in a span of two decades, housing prices grew twice as fast aswages29 (see Table 4-13). The fair market rent of a 2 bedroom unit in Lincoln County is $659/month 30,and the estimated average hourly wage for a Lincoln County renter is $8.80. The affordable rent, typicallyno more than 30% of gross monthly income31 would be $441. This means that the average renter inLincoln County would need to work ten hours a day, seven days a week to afford the fair market value ofa 2-bedroom unit 32. A list of supported affordable housing in Lincoln County is available in Appendix G.The Lincoln County Workforce Housing Needs Assessment completed in 2011 found that rental rates inthe county are high. Much of the rental units available, both apartments and homes, are older, often not ingood repair (See Table 4-14), and lack many of the amenities renters require. Lacking affordable housingbrings unintended consequences such as difficulty in attracting and retaining qualified workers, and manyworkers are often forced to commute long distances (into Benton County, for example) from their homesas they find themselves (doctors, teachers, service workers in leisure and hospitality employment) pricedout of the rental market. Many workers even double-bunk with friends and/or family or „rough‟ sleep incampers and cars just to maintain even part-time employment. Table 4-13. Rental Costs in Lincoln County School District 33 Monthly Rental Lincoln County School District % Oregon U.S. Occupied Units Paying Rent 6,408 100% 519,755 35,969,315 $199 or Less 229 3.57% 1.89% 2.25% $200 to $299 348 5.43% 2.35% 3.41% $300 to $499 849 13.25% 8.10% 9.80% $500 to $699 1,866 29.12% 23.34% 19.41% $700 to $999 1,974 30.81% 37.56% 29.88% $1,000 to $1,499 927 14.47% 20.25% 23.51% $1,500 to $1,999 144 2.25% 4.52% 7.56% $2,000 or More 71 1.11% 2.00% 4.16% Median $692 - $795 $841Additionally, the practice by property owners and funders alike34 to require individuals to have no felonyconvictions may exclude the majority of individuals in early recovery and those whose life historyincludes criminal activity. For some CSCHS families, this may create another barrier to housing that isinsurmountable especially given limited affordable housing options and employment suitable for ex-offenders.29 Lincoln County Workforce Housing Needs Assessment 2011.30 HUD Data Sets, http://www.huduser.org/portal/datasets/fmr.html.31 The U.S. Census Bureau considers a family to be cost-burdened if it is paying more than 30 percent of its gross income for housing and severely cost burdened if it is paying more than 50 percent of its gross income for housing. In Lincoln County, more than half (56.8 percent) of all households are paying 30 percent or more of their monthly income for housing.32 National Low Income Housing Coalition – Out of Reach 2012.33 USA.com Lincoln County Oregon School District; based on 2006-2010 data.34 http://www.rurdev.usda.gov/SupportDocuments/3560-2chapter06.pdf. 17
  22. 22. The number and percentage of occupied housing units without plumbing in Lincoln County are shown inTable 4-14. U.S. Census data shows 128 housing units were without plumbing in 2000 while a decreased74 housing units without plumbing were reported in 2010. While lack of plumbing is a tremendous issue,it is not uncommon to find lower-income housing rife with holes in floors, roofs, and walls; heatingsystems that don‟t work (rental and owner-occupied), electrical issues that are dangerous for children, etc.Unfortunately, these types of units are often the only ones available for a population with low-income,bad credit, and any number of other personal issues. Additionally, housing inspections which are requiredof rental assistance programs and Section 8 housing vouchers will „fail‟ such housing in disrepair andthus effectively „remove‟ additional available housing from the low-income renter. Table 4-14. Housing Units without Plumbing, 2006 – 2010 Geographic Occupied Housing Percent Occupied Housing Percent Area Housing Units without Housing Units without Units, 2000 without Plumbing, Units, 2006- without Plumbing, Plumbing, 2000 2010 Plumbing, 2006-2010 2000 2006-2010Lincoln 19,296 128 0.48 20,652 74 0.36County,OregonReport Area 19,296 128 0.66 20,652 74 0.36Oregon 1,333,723 7,025 0.48 1,499,267 9,729 0.65United States 106,741,426 736,626 0.69 114,235,996 602,324 0.534.2.7 Health CareAccording to the Department of Health and Human Services‟ Health Resources and ServicesAdministration (HRSA), the entirety of Lincoln County is considered a Health Professional ShortageArea (HPSA) and additional lists parts of the county as Medically Underserved Areas/Populations(MUA/P).HPSAs are designated by HRSA as having shortages of primary medical care, dental, and/or mentalhealth providers and may be geographic (a county or service area), demographic (low-income population)or institutional (comprehensive health center, federally qualified health center or other public facility).MUA/Ps are areas or populations designated by HRSA as having too few primary care providers, highinfant mortality, high poverty and/or high elderly population. Tables 4-15A and 4-15B provide HRSAdata specific to Lincoln County. Table 4-15A. HRSA-Generated Data for HPSA35Criteria:State: OregonCounty: Lincoln County Discipline: Primary Medical Care, Dental, Mental HealthID: All Metro: All Status: DesignatedDate of Last Update: All Dates Type: All35 Of particular interest are the columns marked „FTE‟ and „# Short.‟ People attempting to be served in the County are well awareof the shortages in providers. 18
  23. 23. HPSA Score (lower limit): 0Results: 21 records found.(Satellite sites of Comprehensive Health Centers automatically assume the HPSA score of the affiliated grantee. They are not listedseparately.) HPSA Name ID Type FTE # Short Score041 - Lincoln CountyLincoln 741041 Single County 1 1 18Lincoln County Health and Human Services 141999412M Comprehensive Health Center 0 2Coastal Health Practitioners 141999412Q Rural Health Clinic 0 16Lincoln City Medical Center 141999412R Rural Health Clinic 0 16 Native American TribalSiletz Community Health Clinic 141999413R 0 13 PopulationDelake/Depoe Bay 141999413X Geographical Area 5 1 8Depoe Bay CCD Minor Civil DivisionLincoln City CCD Minor Civil DivisionLow Income - North Dunes/Siuslaw 141999419S Population Group 0 2 15C.T. 9517.00 Census TractLincoln County Health and Human Services 6419994173 Comprehensive Health Center 11Low Income - Lincoln County 6419994174 Population Group 1 4 18Lincoln Single County Native American TribalSiletz Community Health Clinic 64199941A4 12 PopulationBayshore Family Medicine 64199941AF Rural Health Clinic 0 6Lincoln City Medical Center 64199941AH Rural Health Clinic 0 23Coastal Health Practitioners 64199941AI Rural Health Clinic 0 23Lincoln County Health and Human Services 7419994149 Comprehensive Health Center 12 Native American TribalSiletz Community Health Clinic 7419994158 13 PopulationLincoln City Medical Center 741999416D Rural Health Clinic 0 22Coastal Health Practitioners 741999416E Rural Health Clinic 0 22 Table 4-15B. HRSA-Generated Data for MUA/PCriteria:State: OregonCounty: Lincoln CountyID #: AllResults: 8 records found. Name ID# Type Score Designation Date Update DateLincoln CountyYachats Service Area 07080 MUA 49.80 2001/09/13CT 9517.00Low Inc - North Lincoln 07327 MUP 61.40 2003/04/11MCD (90884) Depoe Bay CCDMCD (?) UnknownLow Inc - Toledo 07378 MUP 60.80 2003/10/16MCD (91020) Eddyville CCDMCD (93230) Toledo CCDIn Lincoln County, three of Samaritan Health Services hospitals are officially designated as ruralfacilities, and they partnered with the Federal Office of Rural Health to form special collaborations toaddress the particular needs of rural residents. The partnership, known as a Community HealthImprovement Partnership (CHIP), has been active in Lincoln County (Samaritan North Lincoln andSamaritan Pacific Communities hospitals) since 2002. 19
  24. 24. In Lincoln County, the identified CHIP priorities are: Childrens health School-based health clinics Chronic disease management Affordable health insurance Healthy communities promotion Access/referral to health services.At one time, the four school-based health clinics in Lincoln County had lost state funding and were indanger of closing their doors. By using data from the original health care gap assessment, the CHIPpartners were able to leverage initial CHIP seed money for bridge funding and other grants and all fourcenters continue to operate. Additionally, the Lincoln County CHIP sponsors a childrens health fair thatprovides free immunizations and was selected to be one of Oregons pilot-site counties for the HealthyCommunity initiative and is working with the Kellogg Foundation to look at school-based clinics.Additional Lincoln County projects include: Working with high school media departments to produce theater-related activities encouraging self- esteem and good decision-making among local teens. Working with the Parish Nurse Program to set up classes to help parents initiate parent-teen talks. This was a result of hearing parents express a need for tools to help them talk to their children about sex and other teen behavioral concerns. Working with Medical Teams International to provide needed dental services.4.2.7.1 MedicalWhen it comes to covering kids with health insurance, Oregon is a step ahead of national health carereform36. Healthy Kids provides health coverage to all uninsured Oregon children, and no family earnstoo much to qualify37. Healthy Kids covers all necessary care: doctor visits, dental care, vision,prescription medicines, mental and behavioral health care, and more, with no hidden deductibles or highco-pays. Even kids with current health conditions can enroll, and national healthcare reform protects theHealthy Kids program for years to come.CSCHS reports that 96% of enrolled children are covered by OHP, Oregon‟s traditional Medicaidprogram. Healthy Kids is an alternate insurance coverage available to Oregon children. Table 4-16 showsthe OHP-accepting pediatricians and family medicine doctors in Lincoln County.For children covered through private insurance, national health reform is making importantimprovements: Health care reform eliminated pre-existing coverage exclusions for children. Pre-existing-condition clauses had been a barrier to health care coverage for children. This meant that children with serious medical problems couldn‟t get the health coverage they needed. Children‟s dental and vision needs will be covered beginning in 2014. Healthy Kids covers dental and vision care but many private plans don‟t. National reform requires coverage of not only basic pediatric services under all new health plans, but also dental and vision needs. The insurance exchange, a key component of national health reform, will provide a central marketplace for health insurance, which puts families in charge of their child‟s health care and provides options. The exchange will provide one-stop shopping for individuals and small businesses to compare rates, benefits and quality among plans. The exchange will also administer the new federal health insurance tax credits for those who qualify and make it easier to enroll in health insurance.36 at www.oregonhealthykids.gov.37 A family of four earning as much as $66,000 a year qualifies for subsidized, low-cost coverage. 20
  25. 25. Oregon‟s insurance exchange will complement the Healthy Kids program by providing more healthinsurance choices to families without job-based coverage and providing tax credits to those who can‟tafford it. This program ensures that children have access to affordable child-only health insurancepolicies, regardless of whether their parents change jobs, leave a job, move, or get sick. Health carereform will improve the quality of care children receive. Table 4-16. Pediatric and Family Medical Providers Accepting Medicaid Pediatric and Family Medicine Providers Lincoln CountySean Rash Stephen Burns Linell Wood David Bice Robert KayPediatric Physician Pediatric Physician Pediatric Physician Family Medicine Family MedicineCoastal Pediatric Coastal Pediatric Coastal Pediatric Associates Newport Lincoln CityAssociates Associates Newport Accepts OHP and new Accepts OHP andNewport Newport Does not accept OHP but patients new patientsAccepts OHP and new Accepts OHP and new takes new patientspatients patientsBayshore Family Jennifer Wrazen D. Orton Jerry Flamming TBAMedicine Pediatric Physician Family and Emergency Family Medicine Family MedicineLincoln City Samaritan Waldport Medicine Depoe Bay Depoe BayAccepts OHP Clinic Lincoln City Accepts OHP and new Accepts OHP and Waldport Accepts OHP and new patients new patients Accepts OHP and new patients patientsMarlene Nelson, Meg Lincoln City Medical Samaritan Waldport Clinic Samaritan Toledo John LeherPortwood Center Waldport Clinic Family MedicalCoastal Health Lincoln City Toledo ClinicPractitioners Accepts OHP NewportLincoln City Theresa Curran, PA Samaritan Coastal Clinic Lincoln CityTable 4-17 shows the total institutional Medicare and Medicaid providers, including hospitals, nursingfacilities, federally qualified health centers, rural health clinics and community mental health centerscurrently available in Lincoln County38. Table 4-17. Institutional Medicare and Medicaid Providers, Second Quarter, 2011 Community Total Federally Rural Mental Geographic Institutional Nursing Qualified Health Health Health Area Providers Hospitals Facilities Centers Clinics CentersLincoln County 21 2 2 8 4 0Oregon 672 68 138 104 64 12United States 75,166 7,195 15,714 4,923 3,899 63338 U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Provider of Services File,Second Quarter, 2011. 21
  26. 26. Table 4-18 shows 2011-2012 CSCHS data for enrolled children with respect to health insurance andmedical home. Table 4-18. Medical Information for CSCHS Enrolled Children 2011-2012 School YearTable 4-19 shows 2011-2012 CSCHS data for enrolled children with respect to medical servicesprovided. Table 4-19. Medical Information for CSCHS Enrolled Children 2011-2012 School Year 22
  27. 27. 4.2.7.2 Mental HealthAccording to available data39, currently practicing in Lincoln County there are counted six counselors,seven clinical social workers/therapists, 1 marriage/family therapist, 1 substance abuse counselor, and 1certified and registered psychologist, all of which list children as an aspect of their practice. It is unclear,however, how many (if any) of those professionals accept OHP 40. When the search is expanded to includeneighboring county opportunities, the number of available mental health professionals greatly increases.The American Mental Health Alliance regularly updates and makes available to practitioners and librariesprinted directories of therapists throughout of the Portland area and Oregon 41.Locally, low- and no-cost mental health services can be accessed through Lincoln Community HealthCenter (locations in Newport, Lincoln City, and South Beach), which is supported through LincolnCounty Health and Human Services Department, Federal HRSA grant, Oregon Department of HumanServices, Lincoln County, and funds through donation, foundations, and patient fees. Additionally, thereis a toll-free telephone number available for mental health emergencies, and the Children‟s AdvocacyCenter in Newport is also listed as available for working with child mental health concerns.In 2011, the last period for which data is available, only 7% of children statewide receive needed mentalhealth services, with the last two quarters of that year seeing a 10% drop in that 7% served. Conversely,enrollment in OHP increased overall by 4% in the same timeframe. It would be positive to think thatfewer children need mental health services, but in areas such as Lincoln County, the downturn in mentalhealth service provision is more likely due to lack of available local providers.Currently, for Lincoln County residents on OHP, the primary mental health provider is AccountableBehavior Health Alliance (ABHA) which is located in Benton County, Corvallis specifically. Thoughthere are contracted ABHA providers who specialize in children, none are located in Lincoln County, sofamilies must travel substantial distance (40 miles or greater) for this vital service. Table 4-20 shows2011-2012 CSCHS data for enrolled children.39 American Mental Health Alliance, Psychology Today.40 http://www.oregon.gov/oha/amh/child-mh-soc-in-plan-grp/docs/brs-provider-list-county.pdf - no providers listed in LincolnCounty who serve children and accept OHP.41 http://or.americanmentalhealth.com/freeprintdirectory.trust?cart=13597328832166374. 23
  28. 28. Table 4-20. Mental Health Information for CSCHS Children 2011-20124.2.7.3. Dental CareDental care for OHP participants in Lincoln County is limited similarly as medical and mental healthprovision and also contains no local pediatric specialists. Though potential transportation options areavailable deliver patients to professional offices outside the local area, scheduling and timing continue topresent difficulties for low-income families. Table 4-21 shows the dental provider options available toOHP recipients and, contained within that group, are four local options: two in Lincoln City, one inNewport, and one in Toledo (again, none of whom serve young children). Table 4-21. OHP Dental Providers in Lincoln County 24
  29. 29. 4.2.8 Child CareLack of child care in Lincoln County especiallyfor working parents continues to be a significantneed, and for every 100 children who needchildcare, there are approximately only 19 slotsavailable with licensed facilities. Of course thereare opportunities for child care in unlicensedprivate and family homes, but these facilities arenot eligible for State subsidy if any is available.According to OSU‟s Childcare ResearchProject, childcare costs about $35 a day perchild, and public subsidies for childcare havebeen significantly reduced in recent years.Figure 4-3 shows who pays for childcare inOregon.4.2.8.1 Child Care AssistanceThe Employment Related Day Care program(ERDC) helps eligible low-income workingfamilies pay for child care which assists lower-income parent obtain and maintain employment Figure 4-3. Child Care Fundingas their children are cared-for in stable childcare arrangements. ERDC helps approximately 20,000 Oregon families every year pay for child care forapproximately 35,000 children each year and works with providers and other childcare partners across thestate to help families find and keep good childcare, improve the availability of quality childcare inOregon, and to develop resources for parents and childcare providers.If a parent qualifies for assistance, DHS will pay a portion of their child care bill, the amount of which isbased on the family‟s income, type of child care, and how many hours of child care are needed. Mostparents are required to pay part of the cost, and DHS pays its portion to the family‟s child care providerdirectly. Providers must apply and pass a background check to participate.The number of families served is based on the program‟s budget, and the program budget and caseloadmaximums are set by the Oregon State Legislature. The caseload maximums started July 1, 2011: July 2011 through December 2011: 9,000 cases; January 2012 through December 2012: 9,500 cases; and, January 2013 through June 2013: 10,000.When the caseload maximum is reached, a reservation list will be created. As there are openings, familieson the waiting list will be randomly selected and invited to apply – within 30 days – for the subsidy.Additional, non-subsidized childcare resources might be available through the Oregon ChildCare Resource and Referral Network42 and/or the Family Care Connection which is operated through theOregon State University Extension Service43.42 http://www.oregonchildcare.org.43 http://extension.oregonstate.edu/lincoln/family_care . 25

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