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E5CF-Final-Report-2016

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E5CF-Final-Report-2016

  1. 1. 1 ASPIRING TOWARDS A COLLABORATIVE SYSTEM OF CARE ERIE COUNTY COMMUNITY COORDINATING COUNCIL ON CHILDREN & FAMILIES
  2. 2. 2 Suggested Citation: Erie County Community Coordinating Council on Children and Families. (2016). Our Shared Responsibility: Aspiring Towards a Collaborative System of Care. Erie County, New York. Copyright, Restrictions, and Permissions Notice: Except as noted herein, materials contained in this report are in the public domain. Public domain information may be freely distributed and copied. However, not all photographs in this re- port are in the public domain. Some photographs were contributed by or licensed from private individu- als, companies, or organizations that may be protected by U.S. and/or foreign copyright laws. Transmission or reproduction of items protected by copyright may require the written permission of the copyright owner. Source for photographs on the cover and pages 4, 5, 12, 17, 22, 25; Pixabay.com, Public Domain Images Source for photographs on the pages 8, 15, 16, 19, 20; licensed from Shutterstock. Copywriting & Design: Eric J. Tower, Community Coordinator
  3. 3. 3 ERIE COUNTY COMMUNITY COORDINATING COUNCIL ON CHILDREN & FAMILIES Council Members Robert M. Bennett Chancellor Emeritus Board of Regents Jack F. Coyne Pediatrician, Medical Director Child Advocacy Center of Buffalo & Niagara Amber M. Dixon Executive Director Buffalo Center for Arts and Technology Ellen M. Fischer Executive Director Cheektowaga Youth and Recreational Services Mary Iwanenko Director, Pediatric Educational & Diagnostic Services Erie County Medical Center Corporation James McDonald Assistant Director Northtowns Boys & Girls Club Heidi Milch Executive Director Community Connections of New York Mary Travers Murphy Executive Director Family Justice Center Emily Nelson-Gerken Detective Deputy Erie County Sheriff’s Office David Rust Executive Director Say Yes Buffalo Tracy Sawicki Executive Director Peter and Elizabeth C. Tower Foundation Nancy J. Smyth Dean University at Buffalo School of Social Work Francisco M. Vasquez President & CEO Child and Family Services Ex-Officio Members Gale Burstein Commissioner Erie County Department of Health Frank Cammarata Executive Director, Erie County Office for the Disabled Al Dirschberger Commissioner Erie County Department of Social Services Brian McLaughlin Commissioner Erie County Department of Probation Michael Ranney Commissioner Erie County Department of Mental Health
  4. 4. 4 Sharon Rochelle First Deputy Commissioner, Family Wellbeing Erie County Department of Social Services Mary Martin Director, Special Needs Division Erie County Department of Health Marni Bogart Director, Legal Affairs Division Erie County Department of Social Services Eric J. Tower Community Coordinator Erie County Department of Social Services Tanice R. Pendergrass Family Support Specialist Supervisor Say Yes Buffalo Erin Holbrook Childhood Development Specialist United Way of Buffalo & Erie County Melodie Baker Program Director, Education Initiatives United Way of Buffalo & Erie County Lynn Pullano Chief Executive Officer Child Care Resource Network Amanda Kelkenberg Director of Community Outreach Child Care Resource Network Amber Slichta Vice President of Programs Wilson Foundation Anne Monin Coordinator Lancaster Family Support Center Anne Nowak Coordinator Sweethome Family Support Center Mary Lavin Principal Windermere Elementary School Special Thanks to those that played host to the monthly meetings of The Council United Way of Buffalo & Erie County The John R. Oishei Foundation Buffalo Center for Arts & Technology Child & Family Services ERIE COUNTY COMMUNITY COORDINATING COUNCIL ON CHILDREN & FAMILIES Thank you to the organizations and staff in our community whose commitment of time, effort, and resources to the task of this council helped to focus attention on the barriers that must be navigated daily to accomplish their good works.
  5. 5. 5 This Council recognizes that many variables can negatively affect the conditions of children and families in our community, but the most severe consequences are created by a life of poverty. The lasting effects of trauma inflicted on a child or family by a life of poverty, and how that trauma can cost a community in long- term resources and heart ache could fill many reports. However, in our work we found it necessary to step back even further to address the larger issues that impede the creation of a system of care better able to address poverty and trauma through the sharing of information, collaboration, earlier intervention, cross system prevention, and strategic insight. -Erie County Community Coordinating Council on Children and Families, July 2016
  6. 6. 6 It has been the task of the Erie County Community Coordinating Council on Children and Families (the “Council”) to review the system of care as it currently exists in Erie County, and to offer recommendations for changes in regulation, operating policy, and deployment of resources to strengthen the conditions of children and families in this region, as charged by the Erie Coun- ty Legislature and County Executive. Although the Council was appointed to advise the government, the recommendations presented in this report speak to the whole community of providers. While Erie County government has historically been the central service provider, this Council recognizes that over the last several decades’ services have shifted to a network of providers and institutions that have a shared responsibility to work towards a collaborative system of care, where the County government is only one of many leaders. In this report the Council refers to the concept of a collaborative “system of care” as a way of discussing the whole system that not only recognizes the breadth and scope of service providers for families, but also the philosophical view that all providers in the community have a shared responsibility for the conditions of children and families in Erie County. The Council, having re- viewed the broad scope of services available, has determined that the current operating philosophy that places providers in isolated silos, leaves families to navigate a confusing maze of services, must shift towards a more collaborative systemic ap- proach. The collaborative “system of care” concept is an aspira- tional way of discussing the current network of service providers in Erie County to identify space for needed collaboration, but does not imply the existence of a centrally coordinated system. Collaborative System of Care: An organizational framework that involves formal and informal collaboration across agencies, fami- lies, and youth for the purpose of improving access and expand- ing the array of coordinated community-based, culturally and linguistically competent services and supports for children, youth and families with serious emotional disturbance. The collaborative system of care that surrounds children and families in New York State and Erie County in particular is siloed, duplicative in data collection and services, and inconsistent in its EXECUTIVE SUMMARY
  7. 7. 7 approaches to problems. The model of the collaborative system of care as the Council envisions it is comprised of hundreds of primary service providers, such as government services, schools, and medical providers, and hundreds more of secondary service providers who also touch the lives of families, such as police, public health, and community agencies, who have overlapping domains as illustrated in the figure above. All of these providers touch the lives and homes of children and families in Erie County and therefore hold a shared responsibility to help when they recognize a problem, even when it does not explicitly fall into their service domain. However, under current conditions fulfilling that responsibility has been made burden- some by overlapping regimes of privacy laws that make provid- ers shy away from sharing information, and would require par- ents to send releases to dozens of potential providers, before those providers could discuss their problem openly together. A family involved in a Child Protective Services case will have their child screened for developmental issues, and may have the child referred by a case manager to Early Intervention, but there is currently no systematic way to follow up with to ensure that a family has taken advantage of that referral without violating privacy laws. With only a few exceptions where agencies and government have started to coordinate case management, the system of care relies heavily on the family in need to move from silo to silo and to manage their needs alone. The need for a shift towards a system of coordinated care is al- ready well recognized in the health care system where the Af- fordable Care Act and Medicaid reforms are demanding a shift in that direction. One of the largest moves in the direction will occur in late 2016 and early 2017 with the launch of Health Homes for Children in New York State. These Health Homes are intended to help coordinate the care needs for children with chronic health conditions or serious mental health concerns. The extent to which these new health homes for children will be able to address problems of system navigation for families with children with chronic health concerns remains to be seen, but
  8. 8. 8 represents a significant reworking of the current system of care from responsive care to preventive care. The recommendations put forward in this report attempt to lay the groundwork for a similar shift from responsive care to pre- ventive care in services across the system of care in Erie County by encouraging the sharing of information, the creation of cross- provider strategic partnerships, the development of community assets, and the collaborative use of existing databases on all issues to develop studies that can provide strategic insight into the best preventive use of existing resources. In addition, the Council recommends a series of minimum benchmarks for evaluating the conditions of the community in which children and families reside. These minimum benchmarks have been codified in the form of the Erie County Children’s Bill of Rights included in this report of recommendations. The Chil- dren’s Bill of Rights will be utilized by the Council as the instru- ment by which they will continuously measure improvements, engage service providers, and evaluate the effectiveness in the collaborative system of care. The Erie County Community Coordination Council on Children and Families asserts that the Children’s Bill of Rights applies to all youth, regardless of race, religion or abilities; whatever they think or say; or whatever type of family from which they come. It does not matter where children live, what language they speak, what their parents do, whether they are boys or girls, the culture with which they identify, whether they have a disability or whether they are rich or poor. Every child should be treated fairly on every basis.
  9. 9. 9 RECOMMENDATIONS IN BRIEF  All primary service providers should adopt the Erie County Children’s Bill of Rights as a framework for setting minimum benchmarks in evaluating the conditions of children and families in their community.  Primary providers of education, healthcare, and government services should collaborate and dedicate legal expertise to create a Universal Release for the Coordinated Care of Children and Families. A single release form for families to give permission to existing providers to share information with each other from any point in the collaborative system of care.  Primary providers of education, healthcare, and government services should commit technical expertise to create an information dashboard for data on Children and Families, similar to the New York State dashboard, in which all local providers would help to contribute data.  Erie County government should continue to encourage the collocation of staff and resources from agency and government service providers as the best way to leverage a wide array of expertise and coordinate care for children and families.  Primary providers of education, healthcare, and government services should support the broad imple- mentation of Trauma Informed Care across all service providers, including all health and human services employees, policing agencies, and community agencies.  Erie County government and primary providers of healthcare should help support the hiring of a full-time child abuse specialist pediatrician to work in local area hospitals with CPS, police investigators, and other service providers similar to the REACH program at the at the Golisano Children’s Hospital in Rochester, NY.  Erie County government should help to develop the local non-profit community through capacity build- ing that will result in the delivery of services at the highest possible quality level, lowest possible cost, and biggest impact in the community.  Erie County government should work to eliminate the waiting list for parental education programs, by conducting a full survey of all providers to determine quality of program, demand for service, and access for young parents.  Erie County government should continue to encourage the expansion of youth development programs and activities as a preventive measure, and foster the expansion of such programs into all areas of the County.  Primary providers of education, healthcare, and government services should leverage existing databases in partnership with research foundations to sponsor longitudinal studies of at-risk populations in Erie County. Detailed recommendations can be found on page 27
  10. 10. 10 01. Clean water and a balanced, healthy diet of fresh food. 02. Live a life free from neglect and violence. 03. Sleep each night in a safe home in a secure community, free from envi- ronmental contamination. 04. Play safely outdoors in their community with other children. 05. An economically secure family with access to basic needs of daily life. 06. A place in a welcoming family with a loving guardian who will nurture them as they grow. 07. A stable life where they can make and keep healthy relationships with friends. 08. An enriching, safe educational environment where they can explore and fulfill their greatest potential. 09. Self-determination appropriate to their age and growing mental capaci- ty as individuals, and legal advocacy to express that self-determination. 10. Access all forms of healthcare needed to stay healthy physically and mentally. 11. Be encouraged by family and community to grow through challenges that may be faced and mistakes that may be made. ERIE COUNTY CHILDREN’S BILL OF RIGHTS
  11. 11. 11 The Children’s Bill of Rights will be utilized by the Council as the instrument by which they will continuously measure improvements, engage service providers, and evaluate the effectiveness in the collaborative system of care.
  12. 12. 12 The Erie County Community Coordinating Council on Children and Families, re-established by the Legislature in Local Law 3 – 2014 as recommended by the County Executive, was charged with the task of offering recommendations to strengthen the services system for children and families in Erie County. In particular, to perform the following duties: 1. Develop a methodology to evaluate, monitor and ascertain the effectiveness of current programs in children’s services. 2. Identify problems and deficiencies in existing services and recommend corrective action. 3. Improve coordination of program and fiscal resources within the children’s services system. 4. Act as a liaison between county government units, public vol- untary programs, and the State and Federal government, fostering better communication between all involved. 5. Review and resolve administrative, and where appropriate, regulatory difference between agencies. 6. Develop long-range plans to improve services to children and families. This should be accomplished through a five-year comprehensive service plan similar to those utilized by County Departments. 7. Act as a forum for community discussion of issues pertaining to services for children and families. 8. Carry out any and all activities deemed necessary to accom- plish the goals of the council as stated herein. Poverty, unemployment, hunger and health problems are issues that exist in pockets in every community across Erie County. When a family faces a crisis, the best indicator of how they will recover and proceed in the future is the strength of the supports their community is able to lend. In a survey of 40 local cases by University at Buffalo researchers, the majority of families in crisis (92%) had significant financial stressors and/or were living in poverty, and reported a lack of social support, feelings of isola- tion and being overwhelmed. In addition, these families were more likely to have extended families dealing with their own issues of substance abuse and child maltreatment.1 The Council on Children and Families has met once a month since it was seated in early 2015. In that time the Council has collected and analyzed data from, and interviewed experts in, many fields and researched topics that affect the strength of services, and conditions surrounding children and families, in- cluding: Healthcare, Education, Social Services, Public Health, Mental Health, Criminal Justice, Community Support. This Council recognizes that many variables can negatively affect the conditions of children and families in our community, but the most severe consequences are created by a life of poverty. The lasting effects of trauma inflicted on a child or family by a life of poverty, and how that trauma can cost a community in long-term resources and heart ache could fill many reports. However, in our work we found it necessary to step back even further to address the larger issues that impede the creation of a system of care better able to address poverty and trauma through the sharing of information, collaboration, earlier inter- vention, cross system prevention, and strategic insight. In the following sections the report broadly illustrates the sys- tem of care as it currently exists, through the lens of the Chil- dren’s Bill of Rights. This is not an exhaustive description of the system as a whole, but merely a broad overview of the ma- jor service providers, funding sources, and the ways in which they interact with one another. Through illustrating the ways in which the complexity of the current system impedes the basic rights of every child, the Council hopes to show the need for the primary providers of education, healthcare, and govern- ment services to focus on removing the barriers to creating a collaborative system of care. INTRODUCTION
  13. 13. 13 The right to Clean water and a balanced, healthy diet of fresh food. Clean Water Water is the most fundamental resource, so much so that we often take it for granted. However, with the recent events in Flint, Michigan, our country and our community has found themselves re-examining the important role that water plays in the health and prosperity of the children of Erie County. The two areas of water quality that have the largest impact on the health of the child are fluoridation of water, and traditional water sanitation testing. According to the American Dental Asso- ciation, fluoride is important to fight tooth decay by encouraging re-mineralization of the teeth.2 In Erie County, 95% of children are on public water systems with fluoridated water. The remain- ing 5% live in the surrounding rural areas that include three school districts, Akron, Alden, and North Collins schools. The New York State Department of Health targets this population through fluoride treatments to students in area schools and Head Start programs located in these communities. 3 The Public Health Engineering Unit of the Environmental Health Division of the Erie County Department of Health is responsible for the regulation of public water supplies and all residential or small commercial private wastewater treatment facilities and for the review and approval of plans for new or replacement water lines, sanitary sewers, private wastewater treatment systems, public swimming pools and realty subdivisions. The Water Sani- tation Services Office of Environmental Health Services monitors all public drinking water supplies, reviews and approves plans of public water supplies, subdivisions, public beaches, pools and residential sewage disposal systems.4 Lead is not present in the drinking water that is treated and de- livered to the home. Lead in drinking water is largely from ma- terials and components associated with service lines and home plumbing. If present, elevated levels of lead can cause serious health problems, especially for pregnant women and young chil- dren. The Erie County Water Authority, the Buffalo Water Au- thority and other local suppliers are responsible for providing high quality drinking water, but cannot control the variety of materials used in plumbing components. For the vast majority of homes, lead in plumbing is considered a threat only when water flowing through the pipes reaches corrosive levels that can dissolve materials it contacts. Water in Erie County is treat- ed to reduce the corrosive pH level and reduce the risk of the water dissolving hazardous metals in household plumbing. Both the Erie County Water Authority and the Buffalo Water Authority advise in their water quality reports that when water in homes with lead plumbing has been sitting for several hours, lead exposure from plumbing can be minimized by flushing the tap for 30 seconds to 2 minutes before using water for drinking or cooking. Healthy Diet of Fresh Food The provision of food support services in the United States is funded through a single federal agency, the USDA. It funds a number of food programs through New York State that seek to reach individuals and families in need, school children, and to integrate supplies of fresh foods into the programs they fund.5 These federal dollars are monitored by three major New York State Departments: the New York State Department of Educa- tion (in the form of School Breakfast and Lunch Programs), the New York State Office of Temporary and Disability Assistance (in the form of the Supplemental Nutrition Assistance Program [SNAP] and Eat Smart New York Nutrition Education Program); and the New York State Department of Health (in the form of the Women, Infants, and Children Program.) Food support services in Erie County are provided primarily by two independent systems: the educational system - namely local school districts implementing State and Federal nutrition pro- grams; and, the Safety-Net system - namely Erie County Social Services and Catholic Charities administering the SNAP program and WIC programs, respectively. Between these two independent areas, an informal network of some 160 local food pantries and 23 soup kitchens, offer chil- dren and families additional, emergency support when neither the School Districts or safety-net system are able to provide con- sistent coverage.6 In addition, non-profit organizations like Grassroots Gardens of WNY cultivates over 300,000 square feet of land, annually producing over 35,000 pounds of fresh fruits and vegetables, which are freely given to anyone who goes to pick them, and is also donated to the many local food pantries. Local school districts have the largest influence on the nutrition-
  14. 14. 14 al well-being of at-risk children. There are 224 Schools in 30 In- dependent School Districts in Erie County. Each administers applications on behalf of the New York State Department of Education that determines a family's eligibility for the Free and Reduced Price lunch programs, as well as other USDA funded programs like School Breakfast, Summer Meals, and Free Milk. The USDA has a provision in the eligibility rules for students called the Community Eligibility Provision that allows districts with greater than 40% eligible students to offer the free lunch program to all students in the district regardless of income level. This provision was made in an effort to reduce the cost of ad- ministrative time in collecting applications, and ensuring all eligi- ble students are covered. Buffalo Schools and Cheektowaga Central School District are currently the only two districts in the System of Care that are making use of the Community Eligibility Provision that would grant access to free school breakfast and school lunch program to all students at no charge. Additional schools may be eligible. For parents of eligible children outside of the Buffalo School District, their children are automatically eligible for school food programs if they are either receiving SNAP benefits, or are earn- ing less than 130% level of the federal poverty for free school lunch, or 185% for reduced price school lunch. Erie County Social Services determines SNAP eligibility for resi- dents in the System of Care. Application to the program can be done online through the New York State myBenefits website, or in person on Common Application. The myBenefits website al- lows residents to apply for most programs without requiring a face-to-face interview. This has reduced the need for families in rural areas or who have transportation issues to make unneces- sary trips to Social Services in Downtown Buffalo. In addition, Erie County Social Services in partnership with the University at Buffalo School of Social Work, established 8 sites across Erie County where graduate-level interns were available to assist families in applying for benefits online through myBenefits and on the paper applications, in an effort to reach transportation isolated and at-risk communities. Erie County Social Services contracts with a small number of outside agencies to provide nutrition and cooking education to SNAP recipients, and works to encourage recipients to take ad- vantage of the Double-Up Food Bucks program that doubles the amount of money SNAP recipients spend at local Farmers Mar- kets across Erie County. The Double-Up program is part of a USDA program to encourage at-risk populations to eat fresh fruits and vegetables from locally grown farms. Catholic Charities administers the Women, Infants, and Children food and educational program, also funded through New York State and the USDA. In the System of Care they operate in 15 sites across the County to assist eligible women afford food and vitamins for themselves and their children, and to provide edu- cation on child care, and the benefits of breastfeeding. Despite the abundance of food assistance programs available to children and families, many still need to rely on the 160 local food pantries across the County. For some families, the amount of benefits available to them does not provide them enough food. This problem is not unique to Erie County, and has been recognized in many communities across the United States.
  15. 15. 15 The right to live a life free from neglect and violence. Parental Education & Preventive Support Few people set out to harm their children and family. Although these sorts of criminal actors exist, the vast majority of individu- als involved in child abuse and neglect cases are suffering under a combination of poverty, inadequate education, loneliness and social isolation, and the lack of familial supports. The System of Care has a wide variety of education and supportive services available to parents aimed at giving parents the tools to prevent the conditions that lead to abuse and neglect, however The Council believes that an inventory of services and causes of child fatalities by neglect or violence needs to be created to focus preventative work. Beginning with the birth of a child, programs like Ready, Set, Parent from EPIC educates parents in the hospital on a variety of issues. This and other educational programs give new parents an overview on what to expect in the first few weeks, explaining the causes of crying, how to recognize postpartum depression, and on the dangers of shaken baby syndrome. The education is focused on informing parents on the importance of taking breaks to manage the stress caused by having a newborn child, with the aim of preventing instances of frustrated parents shak- ing children - causing lifelong disability or even death. The De- partment of Health also enters this space to educate parents on the dangers of co-sleeping, or sleeping in the same bed as a newborn, and on the health benefits of breastfeeding. Beyond the hospital environment, services like the Family Help Center and the Parent Network of Western New York provide parents with a wide array of educational and support services opportunities. Family Help Center maintains a 24-hour Family Help Line designed to assist frustrated parents at any hour of the night by providing a friendly ear to listen to problems and help connect them to available services to resolve their issues, from one-on-one counseling for parents to how to get help to put food on the table to advice on how to be a good advocate for your child's education, these support centers for parents play a critical preventive role. Programs like Help Me Grow seek to help communities, provid- ers and governments to develop an efficient and effective sys- tem for identifying at-risk children, so that families can find pro- grams and services that meet the needs of their child. By part- nering with parents, child care centers and pediatricians to per- form early developmental screenings, Help Me Grow hopes to identify children in need of assistance from providers like the Early Intervention division of the Department of Health or others that best fit the needs of the child. Only a fraction of local chil- dren currently receives screenings, leaving a large percentage of children in need of attention undetected until they reach school age and have fallen behind their peers. Early identification of developmental issues is critical to connecting children to ser- vices that can help their families care for them. Healthy Families New York, a system funded by the Office of Children and Family Services as part of a nationwide initiative called Healthy Families America, provides home-based services for families with children between the age of 3 and 5 years. The program is offered through Buffalo Home Visiting Program in specific at-risk zip codes in Buffalo, Cheektowaga, and North Tonawanda to help parents meet the challenges of parenting in order to assure the healthy development of their children.7 It helps parents to apply for and connect with needed services, provides families with a support worker who will visit them at home once a week to help educate them, and aims to empower young families to self-advocate.8 School Districts & Collocation Partnerships Once children reach school age the primary access point for the System of Care, outside of the home, becomes the School Dis- trict. Children spend dozens of hours a week in contact with their teachers and administrators in School, making them most likely to notice the signs of abuse and neglect in the life of a child. A recent change in the way the Erie County Social Services operates the CPS Division seeks to take advantage of this touch point by collocating one CPS worker in each School District. This strategy has allowed for teachers and administrators to interact with CPS in a seamless way that allows a qualified person inves- tigate an issue the moment something is suspected, reducing the time spent investigating unfounded claims, and allowing earlier preventive intervention to help parents resolve resource issues or protect the child from abusive situations.
  16. 16. 16 Additional support programs like Say Yes to Education in the City of Buffalo, and the Family Resource Centers or Family Support Centers found in some local school districts act as a central con- nection for children in those schools. These programs help to connect parents and children to needed services for basic needs, health care, mental health counseling, legal assistance, anti- violence mentoring programs and with some programs much more. However, due to financial constraint, many of the 30 dis- tricts in Erie County do not have such support programs. In dis- tricts under such financial constraint, the recent collocation of CPS workers established by Erie County Social Services could act as a model for change in the provision of care to children in Erie County by collocating other government or agency staff in the school districts. Internal to the operations of Erie County Social Services, recent collocation of specialists with CPS in the areas of Domestic Vio- lence, Mental Health, and Addiction hope to reduce the lack of follow through on referrals. Now when families come through CPS who might be dealing with issues of domestic violence, mental health issues, or addiction, onsite staff are able to identi- fy and get them immediate assistance, instead of being referred out to agencies where follow through by families might not oc- cur. Early identification of trauma in the life of a child is critical, particularly in the case of domestic violence where any exposure can cause long term damage to emotional, mental, and social development.9 In addition, the long standing Child Fatality Team, a collabora- tive effort between medical providers, government services, and law enforcement meets once a quarter to review a sample set of child fatalities that occur in Erie County. The Erie County Com- munity Coordinating Council on Children and Families has also formed a subcommittee on child fatalities to similarly collabo- rate for the purpose of producing insights for potential changes to preventive education in the next year.
  17. 17. 17 The right to sleep each night in a safe home in a secure community, free from environmental contamination. Homelessness Making headway against homelessness for children and families in Erie County has met with mixed results over the last three years. While the System of Care has seen a 33% decrease in the number of homeless unaccompanied youth, we still find larger percentages (79%) of homeless families are headed by single- mother households.10 In 2015, 1,175 children under the age of 18 were homeless according to the Homeless Information Man- agement System (HMIS). This population accounts for 27% of the total homeless population in this region.11 In Erie County, the System of Care for homeless children and families begins with Erie County Social Services Homeless Unit. The Homeless Unit determines a person's eligibility for an emer- gency shelter grant, and then helps to find them an appropriate shelter. Currently, 90% of homeless families originate in the city of Buffalo, and over half of those have children that are school age.12 The working definition of homeless varies by the statute govern- ing each segment of the System of Care. Under the McKinney- Vento Act, local school districts are required to keep track of homeless children in their care. McKinney-Vento has a more expansive definition of homelessness than HUD that includes children couch-surfing, unstably housed, and imminently home- less in an effort to identify at-risk families earlier. Under this more expansive definition, McKinney-Vento identifies 3 children as homeless for every 1 identified by the less expansive HUB definition. In 2015, there were 2,656 children identified as homeless under McKinney-Vento, but only 1,175 children identi- fied under the HUD definition. New York State is a right to shelter state, and in the local System of Care there are three types of housing interventions: perma- nent supportive housing, rapid-rehousing, and transitional hous- ing. Permanent Supportive Housing - This housing intervention is managed with a “Housing First” philosophy, which stipulates that clients should receive a housing voucher in conjunction with a small number of mandatory intervention services. Rapid-Rehousing - This housing intervention is managed as an alternative to going to shelters, where families who have experi- enced homelessness before are quickly placed into apartments while they stabilize from the conditions that contributed to their homelessness. This intervention requires case management and has a time-limited rental voucher that the family takes over pay- ment on within a year. Transitional Housing - like Rapid-Rehousing this housing inter- vention has a limited time horizon that is related to the thera- peutic goals that lead to the housing issue. Of the 385 households with children identified in the HMIS sys- tem, approximately 20% of them had their housing crisis ad- dressed by a Rapid-Rehousing intervention designed to reduce longer stays in emergency shelters. Households stayed in this shelter type for an average of 69 days. Another 21% of households with children were placed in Transi- tional Housing, and stayed for an average of 289 days. 65% of households in Transitional Housing leave to a permanent hous- ing situation in 2015. Environmental Health The Erie County Department of Health, Division of Environmen- tal Health is the primary inspector in the area of environmental health for housing, schools, restaurants, children’s camps, swim- ming pools, beaches, septic systems, hotels/motels, mobile home parks, day-care centers, and any other business involved with food. They are the vanguard in establishing an environ- ment for children free from environmental contaminates. There are four front-line programs in the Division of Environ- mental Health: The Healthy Homes and Neighborhoods Program - this compre- hensive community outreach campaign that literally goes door to door in targeted at-risk communities is focused on improving the quality of life for individuals and families by reducing their exposure to home-based health and safety risks:  Reducing residential fire deaths, injury and property loss  Preventing Carbon Monoxide Poisoning  Providing Assistance with Asthma Control  Preventing Unintentional Injuries
  18. 18. 18  Promoting Wellness and Nutrition. Vector and Pest Control - this free-of-charge program is respon- sible for rabies and rodent control, and also includes tick service for Lyme disease identification for health providers, veterinari- ans, and the public. Lead Poisoning Prevention - this program provides community and professional education concerning prevention of lead poi- soning, medical and environmental follow-up, and testing of children up to age six (based on a sliding fee scale) for lead poi- soning. This program was recently expanded in 2016 to bring on more inspectors to cover more ground in Erie County. Immunization Action Plan - this program provides a number of services geared toward increasing immunization rates. The pro- gram conducts education and outreach activities to inform healthcare professionals, daycare providers and other interest- ed groups about the benefits of keeping current on immuniza- tions for children. The program offers assistance with reviewing immunization records in daycare and other settings without pro- fessional staff. It also conducts assessments and follow-up visits with private healthcare providers and clinics for the purpose of assessing immunization levels of children and updates on guide- lines. Immunization education is an element of parental educa- tion in every Erie County birthing hospital.13
  19. 19. 19 The right to play safely outdoors in their community with other children The health and well-being of a child goes beyond the family life and physical health of that child. The well-being of the commu- nity in which a child lives and plays sets the context in which free play and programs can take place and in which the health and moral fiber of a child grows stronger. However, access to free play areas in a safe community is not something that every neighborhood has access to in Erie County. For reasons that range from prevalence of crime to neighbor- hoods being isolated from park areas or a lack of park amenities many children in Erie County do not have the ability to play safe- ly outdoors or do not have spaces for such play. One division of Erie County Social Services that is most in tune with providing opportunities to children around this right to play is the Erie County Youth Bureau. The mission of the Youth Bu- reau is to serve youth and families through helping to develop programs that are focused on advocacy, prevention, and inter- vention designed to strengthen families and communities in Erie County.14 Each year the Youth Bureau offers funding opportunities in three major areas: Youth Development Programs, Runaway and Homeless Youth Agencies, and Summer Primetime Programs. Programs funded under each of these categories are required to provide data on the quantitative and qualitative impact their agency is making in the lives of youth in Erie County. The Youth Bureau also has an ongoing relationship with Community Con- nections of New York to analyze the collected data and better deploy its limited program funding. Providing access to free or low-cost educational opportunities for youth is the focus of many programs throughout Erie County, from the public library system to sports organizations to munici- pal recreation departments to the Boy & Girl Scouts of America. Resources abound in many neighborhoods for children with car- ing adults to guide them in the right direction.
  20. 20. 20 The right to an economically secure family with access to basic needs of daily life Economic security is often referred to as having enough income to meet basic needs and enough reserves to be protected against unexpected financial crises. The economic security of a family is essential to ensuring stability of the family in their home, schools, and community. Children are able to thrive in families where all aspect of their intellectual, emotional and physical development are supported. If families are free of the profound anxiety that comes with economic insecurity they will be able to provide that support. According to 2014 American Community Survey, approximately 19% of families with children under 18 years of age remain in poverty in Erie County.15 The population in poverty was found to be disproportionately families with females as heads of households,16 these findings reflect the findings of the Homeless Alliance of WNY Annual Report 2015 which found that single women households with children were at greater risk of home- lessness because, as they speculated, it is difficult to find afford- able child care for low-wage earners that allows them to man- age their work and childcare responsibilities.17 There are numerous programs available to help families become economically secure, the core of which are the Safety-Net pro- grams overseen by Erie County Social Services; SNAP, HEAP, Public Assistance, Medicaid, Day Care, Emergency Services, and Child Support Services. These programs are focused on helping families to get emergency resources for rent, utilities, food, gen- eral expenses and accessing job training opportunities. Many other groups from local community organizations, to faith-based organizations, to human services providers create an even more extensive network of additional help to families, which is widely recognized as an overwhelming system of assistance to navi- gate. Though we know that many families exist in states of economic instability, the conditions of that instability are unique to each family. For families in the Buffalo Public School District pro- grams like Say Yes to Education can be of great benefit. Their coordination of partnerships with local provider agencies, gov- ernment services and pairing their case management for fami- lies in their district offers families the support needed to navi- gate the unique conditions of their situation.18 Here again, as was noted above in the 2nd right, the School District becomes a natural touch point for coordinated casework around the family.
  21. 21. 21 The right to a place in a welcoming family with a loving guardian who will nurture them as they grow. Permanency Removing a child from their home is the move of last resort for Child Protective workers. Awareness of the long-term effects caused by the trauma of being removed is on the rise across the System of Care. However, when it becomes necessary to re- move a child from their home, establishing a plan for permanen- cy should be the focus of the System of Care. A permanency plan is the shortest route that puts the child back into a loving and stable home for the rest of his or her lives, preferably in the school system in which they are currently enrolled. The details of who can provide the most stable home for a child are decided on by the Erie County Family Court, but the System of Care as a whole provides a variety of options for a child. There are roughly 14 foster care agencies responsible for chil- dren in the local System of Care. These agencies recruit and certify foster families for the placement of children, and handle casework for those children and families. In the unfortunate instance that a child is unable to be placed with a family, some agencies also operate residential homes to house children until a suitable home can be found. Often the most ideal placement for a child is with members of his or her own family, allowing the child the maintain family con- nections and cultural traditions. These types of placement are called kinship placements or “1017” placements, referencing section 1017 of New York Family Court law. Research has shown that kinship care results in children with significantly fewer placement changes in their lives, makes it easier to place siblings together, and has significantly fewer instances of runaway com- pared with both foster care and group care.19 In instances where a child cannot be placed with his or her rela- tives the best possible alternative is to be placed with a certified foster family. These families volunteer to provide children with a loving, stable home environments while their biological par- ents work to fulfill the necessary requirements to be reunited with their children. The System of Care in Erie County is current- ly suffering under a shortage of foster families to meet the de- mand for placement by the foster care system. To address this shortage Erie County and foster care agencies have come to- gether to collaborate on a joint recruitment effort. In February of 2016 they sponsored a Foster Family Fair where current fos- ter parents would be able to present and answer questions for prospective foster parents. In addition, these sponsoring agen- cies are partnering with Western New York 2-1-1 referral service to develop an agency neutral recruitment system. A recent change in the System of Care is a partnership between foster care agencies and Erie County Social Services called the Open Arms Committee. The founding agencies of this com- mittee have made a commitment to work together to create permanency plans for children with disabilities, behavioral is- sues, or other conditions that make traditional placement diffi- cult. Meeting on a monthly basis, this group has committed to staying together in the meeting until a plan is created for each child.
  22. 22. 22
  23. 23. 23 The right to a stable life where they can make and keep healthy relationships with friends. There are many obstacles that can stand in the way of a stable childhood; these include poverty, neglect, and abuse. This report and many others can have taken pains to tabulate and measure them. However, it is only recently in the System of Care that as a community of providers we have recognized that even our assistance can also be a threat to a stable childhood. Many primary providers in the collaborative System of Care have come to recognize through the principles of Trauma Informed Care that many of the programs designed to assist children and families fail to address the damage done by removing a child from their home, school, routines, and so on. To that end, re- cent changes by Erie County Social Services hopes to address the way in which its Foster Care programs can disrupt the child and family through the use of Trauma Informed Care. Where appropriate the focus will be on keeping a child in their family through Kinship Care so that they can maintain connec- tions with the family and culture. Through working with individ- ual schools and districts it aims to keep the child enrolled in their existing school where they can maintain important connec- tions with their teachers, friends and classmates. Supporting quality visitation time with their parents so that the parental bond can be maintained as the parent moves towards reuniting with their child.
  24. 24. 24 The right to self-determination appropriate to their age and growing mental capacity as individuals, and legal advocacy to express that self-determination. The System of Care in Erie County recognizes that the child is a partner in determining the direction of his or her life. The self- determination of the child is legally recognized in the Family Court process through Child Advocacy lawyers, who represent the will of the child before the court in matters of foster place- ment. However, the greater part of providing for a child’s growing mental capacity and self-determination as an individual is ensur- ing access to mental health care for children. Access to mental health care is key for youth to address the variety of traumas, social-emotional, and behavioral issues they face in their lives, so that they can begin function more effectively as growing indi- viduals. Currently there is a nationwide shortage of certified mental health specialists for children in both psychiatry and psycholo- gy,20 which is reflected in the shortage of mental health provid- ers for children in Erie County. With the continued changes to the health care system around case management, specifically health homes for children, the ways in which primary providers of mental health refer and provide for the mental health of chil- dren will continue to change over the next two years. The right to an enriching, safe educational environment where they can explore and fulfill their greatest potential. The local school district is perhaps the central most figure in the life of a child beyond their parent or guardian. As it has been stated earlier in this report the large span of time that local school districts have with a child makes them a crucial touch point in wrapping services around a child and in helping to reach further to assist families in need. Programs like Say Yes to Education, Family Resource Centers, and Family Support Centers offer districts who can afford to sup- port them, access to support services for students that help to address issues of poverty, social-emotional problems, and devel- opmental issues. However, many districts cannot afford these types of support programs for their students, and the weight of managing these issues can often fall to teachers and administra- tors.
  25. 25. 25
  26. 26. 26 The right to access all forms of healthcare needed to stay healthy physically and mentally. Access to healthcare services of all types for children and fami- lies is imperative to the healthy development of children and to the economic security of the family.21 Federal programs like the Children’s Health Insurance Program (CHIP) provide states with matching funds if they expand Medi- caid eligibility standards in their state to at-least 300% of pov- erty; in New York State child eligibility for CHIP is 400% of pov- erty.22 This program is one of the core mechanisms for address- ing early health problems in the life of a child, but in Erie County there are some towns and neighborhoods where 9% to 10% of pregnant women will receive late or no prenatal care before giving birth.23 This program grants children and pregnant wom- en critical access to health coverage. The role of Erie County government in providing health care is limited to education about programs and helping to screen for eligible individuals. The Erie County Department of Health works to coordinate with the health care community to ensure that individuals are made aware of and signed up for programs like CHIP and other health insurance programs using facilitated enrollers. Erie County So- cial Services screens individuals applying for public assistance benefits for Medicaid eligibility. Access to healthcare is important for the preventive care that it provides. By recognizing problems in their early stages doctors are able to refer children with early signs of medical problems to care that can prevent long term health consequences. Encour- aging providers to engage in preventive care practices rests mostly in the hands of New York State and private insurance providers as they implement Delivery System Reform Incentive Payment (DSRIP) Program.24 DSRIP is a Medicaid redesign initia- tive aimed at reducing avoidable hospital visits by 25% by the end of 2018 by offering funds aimed at system transformation, clinical improvement, and population health improvement.25 Another Medicaid initiative underway to help individuals man- age care is Health Homes targeting both adults and children. The goal of the health home is to assist individuals with complex medical problems navigate the health care system. Health Homes focused on children are currently being certified by New York State and will be launched later in 2016 to assist parents in managing the care of their children.26 In New York State there are highly specialized programs that have been designed to address the medical issues of children facing child abuse. The REACH program at the Golisano Chil- dren’s Hospital in Rochester, NY is one such program that collo- cates the physical and mental health expertise together in one location to address all aspects of the trauma suffered by an abused child.27 Currently there is no comprehensive medical team for childhood trauma in the Collaborative System of Care.
  27. 27. 27 The right to be encouraged by family and community to grow through challenges that may be faced and mistakes that may be made. Involvement with the Juvenile Detention system in Erie County should not mark the end of a child’s path to developing into a productive member of society. Research indicates that the brain does not reach full maturity until nearly age 25, leaving policy makers to re-examine the ways we assign culpability to adoles- cents.28 The opportunity to learn from the mistakes that have been made, under the guidance of a strong mentor and role model, must always remain available for the offending youth. Beyond the actions of the youth, attention must be paid to the System of Care around Youth Detention to ensure that children are not needlessly involved in the Juvenile Detention system. Programs like Erie County Youth Services’ Juvenile Detention Alternative Initiative (JDAI) recognize the reality that youth placed into detention centers are at increased risk for further offending behavior that can seriously diminish their future pro- spects.29 Similarly the Family Services Team’s PINS Diversion program is aimed at helping parents resolve problems with at- risk youth, and stabilize the situation at home.30 The Erie County summer youth employment program is a program administered by Buffalo Employment & Training Center and certified by Erie County Social Services to give at-risk youth in Erie County the opportunity to be a responsible member of society through paid employment while accessing development programs.31 Recognition that children are learning members of our society who sometimes make mistakes and who are worthy of for- giveness is not something that can be legislated into existence in every case. Every independent school administrator, police officer, family court judge, caseworker, parent, foster parent, and members of the public must bring themselves to the under- standing that all youth have a right to be encouraged to grow through their challenges and mistakes towards a productive fu- ture.
  28. 28. 28
  29. 29. 29 Children’s Bill of Rights All primary service providers should adopt the Erie County Children’s Bill of Rights as a framework for setting minimum benchmarks in evaluating the con- ditions of children and families in their community. Each service provider should adopt and incorporate the Erie County Children’s Bill of Rights into their organization, using it as a framework for approaching their affect in the community that they serve. Primary service providers, especially those in government services should use the Bill of Rights to develop a common framework for measuring the state of children and fami- lies in the communities for which they are responsible. Encouraging Information Sharing Primary providers of education, healthcare, and gov- ernment services should collaborate and dedicate legal expertise to create a Universal Release for the Coordinated Care of Children and Families. A single release form for families to give permission to ex- isting providers to share information with each oth- er from any point in the collaborative system of care. No current legal framework supporting multiple agency coordination could be found for New York State. There are, however, frameworks for service coordination in the State of Ohio that support a universal release of infor- mation for children and families who want agencies to share information to coordinate care. In the case of the Ohio Family & Children First Council’s release of information framework, parents are able to pick and choose which partnering service agencies can have access to their child’s records to coordinate care and they are able to set an expiration date on that release for each partner agency. This universal release of information ena- bles families to waive some or all of their HIPAA, FERPA, or other privacy rights as best fits their needs, so that their case can be more closely coordinated. Moreover this re- lease can be given from any point that the family enters the system of care, from government services, to the pedi- atrician, to the school counselor. It is the Council’s recommendation that primary providers collaborate to commit legal staff to the creation of a simi- lar universal release of information to begin to lay the le- gal framework for the wider coordination of care in Erie County in partnership with major service providers, hospi- tals, school districts, and academic institutions. Primary providers of education, healthcare, and gov- ernment services should commit technical expertise to create an information dashboard for data on Chil- dren and Families, similar to the New York State dashboard, in which all local providers would help to contribute data. The public availability of data in a format that can be easi- ly understood is the best way for the system of care to track its effectiveness in improving conditions for children and families. It can take months of data collection from many sources for anyone to put together a snapshot of those conditions. In an age of affordable data visualization and web publish- ing, a rudimentary dashboard of data on Children and Families could be produced at no or very little cost. The creation and publication of public data sets in partnership with major service providers, hospitals, school districts, and academic institutions could serve as the basis of fur- ther conversations around collaborations and coordina- tion in Erie County. It is the Council’s recommendation that primary service providers commit to the publication of public data sets on key indicators for Children and Families in a publicly avail- able dashboard, at least twice a year. Creation of Cross-Provider Collaborations Erie County government should continue to encour- age the collocation of staff and resources from agen- cy and government service providers as the best way to leverage a wide array of expertise and coor- dinate care for children and families. Erie County government and service providers have re- cently begun to engage in strategic collaborations de- signed to leverage existing expertise in the system of care RECOMMENDATIONS
  30. 30. 30 in a single location to improve care. One successful exam- ple of the collocation strategy has been placement of CPS workers in School Districts across Erie County. These placements have been reported by school administrators to be a valuable resource for quickly addressing issues re- lated to child protection that arise in their school districts. Similar collocations inside the CPS unit of outside agency staff, outlined in the report, has allowed the CPS unit to immediately deploy services from Mental Health, Domes- tic Violence, Addiction Services, and additional investiga- tors when a case requires it, instead of issuing referrals that could take weeks to address every need. Based on the positive early results of existing collocation collaborations, it is the Council’s recommendation that Erie County government should continue to encourage Departments to explore collocation of their staff outside the County and outside staff inside the County as an effec- tive way to leverage a wide array of expertise and coordi- nate the care of children and families. Primary providers of education, healthcare, and gov- ernment services should support the broad imple- mentation of Trauma Informed Care across all ser- vice providers, including all health and human ser- vices employees, policing agencies, and community agencies. Trauma Informed Care is the organization framework around which the local system of care should organize its collaborative efforts. This treatment framework recogniz- es that understanding and responding to the effects of all types of trauma, emphasizing physical, psychological and emotional safety for both consumers and providers helps people to gain a sense of control and rebuild their lives. While the staff of Erie County Social Services and some local police departments are already undergoing Trauma Informed Care training to raise awareness, other County Departments, outside agencies, and police departments should be encouraged to participate in such trainings. The Council recommends that primary service provider foster support for the broad implementation of Trauma Informed Care across all service providers to expand awareness of trauma in the system of care at large. Erie County government should help support the hiring of a full-time child abuse specialist pediatri- cian to work in local area hospitals in consultation with a team of other medical professionals, as well as CPS, police investigators, and other service pro- viders similar to the REACH program at the at the Golisano Children’s Hospital. Erie County as a whole is currently without a full-time pe- diatrician with a child abuse specialty. The absence of the full-time availability of this type of expertise for local med- ical professionals to consult leaves many potential cases of abuse unidentified. The REACH program at the Golisano Children’s Hospital in Rochester, NY is one such program that collocates physical and mental health expertise to- gether in one location to address all aspects of the trauma suffered by an abused child. There are 28 similar fellow- ship programs across the United States focused on the immediate identification and treatment of abuse and trau- ma in the life of a child. The Council recommends that Erie County government facilitate the creation of a center for excellence partner- ship between the University at Buffalo Medical School, Kaleida Health, and Erie County to support the hiring of a full-time child abuse specialist pediatrician and the collo- cation of physical and mental health expertise with that specialist to address childhood trauma. Development of Community Assets Erie County government should help to develop the local non-profit community through capacity build- ing that will result in the delivery of services at the highest possible quality level, lowest possible cost, and biggest impact in the community. Every year Erie County government and philanthropic foundations fund non-profits that provide community ser- vices in many areas throughout the County from child care to case management to emergency housing. While Erie County and area foundations are important central fund- ing entities in many non-profit budgets, it is also important to recognize that the whole system of care is vulnerable to the vagaries of budget pressures, processes, and unex- pected changed. Moreover, the funding offered through RFPs and grants goes to programming without regard for the duplications of services, growing regulatory cost of operating in a par- ticular service area, and the coordination of outcome based measures. The Council recommends that Erie County government in
  31. 31. 31 partnership with local philanthropic foundations conduct a joint market analysis of the system of care with attention paid towards the duplication of services, regulatory re- quirements, bureaucratic reduction, alignment of outcome based measures, and special costs of operation in each service area. In addition, the Council recommends that this partnership help to develop the management exper- tise in the local non-profit community through capacity building educational opportunities, and help increase the ability of community agencies to seek grant money from outside of Erie County. Erie County government should work to eliminate the waiting list for parental education programs, by conducting a full survey of all providers to determine quality of program, demand for service, and access for young parents. Anecdotal reporting to this Council indicates that young parents could face up to a 4 to 6 month waiting list to get into parental educational programs, leaving young and inexperienced parents in Erie County to fend for them- selves in the most stressful period in the early part of a child’s life. It is critical that parents in need of these edu- cational programs be placed immediately into a program so they can begin to care for their child appropriately from the start of their lives. The Council recommends that Erie County government conduct a full survey of parental education programs to develop a deeper understanding of, the quality of the pro- grams provided the causes for waiting lists, barriers to ac- cess and commit the resources required to eliminate those waiting lists. Erie County government should continue to encour- age the expansion of youth development programs and activities as a preventive measure into all areas of the County. Outcome based youth development programs are a critical preventive investment in the children of Erie County. Giv- ing youth in all areas of the County the opportunity to en- gage with peers and mentors year round strengthens fami- lies and communities and keeps youth out of bad situa- tions. The Council recommends that Erie County government should continue to encourage the expansion of youth de- velopment programs and activities into all areas of the County as an important preventive measure for youth. Develop Studies to Provide Strategic Insight Primary providers of education, healthcare, and gov- ernment services should leverage existing databases in partnership with research foundations to sponsor longitudinal studies of at-risk populations in Erie County. All primary providers in the system of care collect enor- mous amounts of data on children and families suffering from various types of trauma from poverty to abuse to medical and developmental issues. However, very little has been done to use these data to do any longitudinal studies of at-risk populations in Erie County. By studying a population as it ages and either moves through the system of care or reaches self-sufficiency and exits the system of care, we would be able to develop new strategic insights on how to address the underlying prob- lems and prevent them from becoming costly problems in the future. The Council recommends that Erie County government is in a unique position to leverage its existing databases in partnership with other service providers and research foundations to sponsor longitudinal studies of at-risk pop- ulations to develop new strategic insights. Potential future studies to consider include:  Complete analysis of child care needs, current county capacity, and access to child care. The inability of some single mothers to access child care has been sighted by the homeless alliance as a potential cause of home- lessness in that population, and no single organization in the system of care has a complete strategic over- view of the situation.  Complete mapping of funds going to all programmatic areas across all providers to determine what changes could be made to shift resources towards preventive programs to reduce long-term costs.  Complete longitudinal study comparing the effective- ness of differing curriculums used by early parental education programs, to create outcome-based measures for funding such programs.
  32. 32. 32 1 Erie County Social Services, (2015). Highlights from Erie County Chronic Neglect Study. Pg. 8-9 , Erie County, NY 2 American Dental Association, (2016). fluoride supplements, http://www.ada.org/en/member-center/oral-health- topics/fluoride-supplements 3 Erie County Department of Health, (2014). Erie County Community Health Assessment 2014-2017, Pg. 13, http:// www2.erie.gov/health/sites/www2.erie.gov.health/files/uploads/pdfs/cha.pdf 4 Erie County Department of Health, (2014). Erie County Community Health Assessment 2014-2017, Pg 135, http:// www2.erie.gov/health/sites/www2.erie.gov.health/files/uploads/pdfs/cha.pdf 5 USDA, (2016). Food and Nutrition Service, http://www.fns.usda.gov/programs-and-services 6 Most of the food pantries are affiliated with the Food Bank of Western New York. 7 Healthy Families New York, Program Sites, http://www.healthyfamiliesnewyork.org/programsites.html#erie 8 Buffalo Prenatal-Perinatal Network, Buffalo Home Visiting Program, http://www.bppn.org/Buffalo-Prenatal-Perinatal- Network-Programs/Healthy-Families-New-York/1 9 Child Welfare Information Gateway, Impact of Domestic Violence, https://www.childwelfare.gov/topics/systemwide/ domviolence/impact/children-youth/ 10 This number does not include women made homeless by domestic violence, as their information is not currently in- put into HMIS for security reasons. 11 Homeless Alliance of WNY, Annual Report 2015, Pg 24 http://wnyhomeless.org/wp-content/uploads/2015-Homeless -Alliance-Annual-Report.pdf 12 Homeless Alliance of WNY, Annual Report 2015, Pg 6, http://wnyhomeless.org/wp-content/uploads/2015-Homeless- Alliance-Annual-Report.pdf 13 Erie County Community Health Assessment 2014-2017, Pg 135-136, http://www2.erie.gov/health/sites/ www2.erie.gov.health/files/uploads/pdfs/cha.pdf 14 Erie County Youth Bureau, http://www2.erie.gov/youthservices/index.php?q=youth-bureau 15 American Community Survey 2014, http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml? src=CF 16 American Community Survey 2014, http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml? src=CF 17 Homeless Alliance of WNY, Annual Report 2015, Pg 5 http://wnyhomeless.org/wp-content/uploads/2015-Homeless- Alliance-Annual-Report.pdf 18 Say Yes to Education Buffalo, http://sayyesbuffalo.org/supports/family-supports/ 19 Center for Law and Social Policy, Is Kinship Care Good for Kids?, http://www.clasp.org/resources-and-publications/ files/0347.pdf 20 Children’s National Research Foundation, http://childrensnational.org/news-and-events/media-kit/signature-issues/ mental-health CITATIONS
  33. 33. 33 21 Department of Labor, Problems Facing the Working Poor, https://www.dol.gov/dol/aboutdol/history/herman/ reports/futurework/conference/workingpoor/workingpoor_toc.htm 22 Medicaid.gov, New York State Profile, https://www.medicaid.gov/medicaid-chip-program-information/by-state/ stateprofile.html?state=new-york 23 New York State Department of Health, Three-Year Perinatal Data Profiles 2011-2013, https://www.health.ny.gov/ statistics/chac/perinatal/index.htm 24 New York State Department of Health, DSRIP Program, http://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/ 25 New York State Department of Health, About DSRIP, http://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/overview.htm 26 New York State Department of Health, Health Homes, https://www.health.ny.gov/health_care/medicaid/program/ medicaid_health_homes/ 27 University of Rochester Medical Center, REACH program, https://www.urmc.rochester.edu/childrens-hospital/ community-outreach-programs/reach-program.aspx 28 National Institute of Mental Health, Teen Brain: Still Under Construction, http://www.nimh.nih.gov/health/ publications/the-teen-brain-still-under-construction/index.shtml 29 The Annie E. Casey Foundation, JDAI, http://www.aecf.org/work/juvenile-justice/jdai/ 30 Family Services Team, http://www2.erie.gov/youthservices/index.php?q=family-services-team-pins 31 BETC, Erie County Summer Youth Program, http://www.workforcebuffalo.org/youth/erie.asp
  34. 34. 34 ERIE COUNTY COMMUNITY COORDINATING COUNCIL ON CHILDREN & FAMILIES COMMISSIONED BY Mark C. Poloncarz Erie County Executive AND Erie County Legislature Barbara Miller-Williams 1st District, Erie County Betty Jean Grant 2nd District, Erie County Peter J. Savage, III 3rd District, Erie County Kevin R. Hardwick 4th District, Erie County Thomas A. Loughran 5th District, Erie County Edward A. Rath, III 6th District, Erie County Patrick B. Burke 7th District, Erie County Ted Morton 8th District, Erie County Lynne M. Dixon 9th District, Erie County Joseph C. Lorigo 10th District, Erie County John J. Mills 11th District, Erie County

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