Children are the future of any state. That premise lies at the foundation of Oregon Shines. Creating a children's agenda was among the first four steps identified for moving the state toward achieving the "best educated and trained workforce in the country and the world." And both Oregon Shines and the subsequent benchmark reports called for renewed attention to "fostering the well being and development of children in their very early years."(1)
Background: Oregon Shines launched a concerted effort to improve the health, educational, economic, and social conditions for the state's youngest residents. For example, Governor Goldschmidt's report placed particular emphasis on forwarding an ambitious "children's agenda."(2)
As the Oregon Benchmarks were developed and refined over the past six years, children's issues remained in the forefront. All three Progress Board reports present ambitious benchmarks focused on children and families. And the benchmarks adopted by the Healthy Children's Cluster are drawn directly from the Progress Board, Commission on Youth and Families, and the Immunization Consortium.
The Oregon Legislature created the Commission on Children and Families in 1993 to help empower counties to better meet the needs of children and families.(3) The law reflected an important shift in children and family policy. The state placed greater emphasis on prevention rather than remediating the problems of children and families after they reached crisis level. Historically, children were served primarily after a serious problem developed.(4) The new approach, in contrast, focused more on early childhood development, prevention, and strengthening and supporting families. The new agenda included four main elements:(5)
The state commission adopted benchmarks to define core support areas. These included:
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The overall system is driven by local, county-based commissions. Both the state and county commissions serve policy and planning functions. Neither offer direct services to children and families. Rather, they serve as magnets for collaboration and integration across the system of providers within each community. Local commissions were formed in all 36 counties. And comprehensive plans were developed by each of the county commissions. These county plans use the state commission's benchmarks as their core indicators. The use of these statewide core indicators facilitates greater accountability and evaluation within and across counties.(6)
The Healthy Children benchmarks all originated from this earlier work by the Progress Board and the Commission on Children and Families. These benchmarks were first selected in the fall of 1994, months before the federal, state, and local leaders signed the Oregon Option Memorandum of Understanding. In September 1994, a group of about 100 representatives from the state, federal agencies, local governments, and other organizations met to create an outline for the new partnership. During the meeting, a work group of county officials, state representatives, and others first reviewed the existing benchmarks set by the Progress Board, the Commission on Children and Families, and the Immunization Consortium. They proposed nine core objectives for the Healthy Children's Cluster:(7)
Through almost 18 months of effort to turn the promise of the cluster into a reality in Oregon, these nine have remained unchanged as the Healthy Children benchmarks.
In fact, data on these benchmarks are an important part of the strategy to improve progress toward their achievement. During the last year, with help from an epidemiologist and other health statistic experts from the Centers for Disease Control and Prevention, the cluster developed reports and maps with detailed information on current conditions. These reports and data are also being used as a yardstick for analyzing progress on the local level across the state.(8) Data on teen pregnancy rates, for example, were calculated and all of the state's counties received maps that helped them compare how they were faring at cutting this rate over time and in comparison to other counties and the state as a whole. County-level maps were provided for all 9 of the healthy children benchmarks and were distributed to the state's 36 counties.
Evolution of the Healthy Children Benchmarks: The law creating the Oregon Progress Board required the development of specific benchmarks based on the strategic vision proposed in Oregon Shines. Between 1989 and 1991, benchmarks were adopted, baselines set, and progress against these goals was reported in the three Progress Reports to the legislature. The chart on the following page summarizes the development and evolution of these benchmarks across the three reports to the legislature. A more detailed review is found in the appendices.
EVOLUTION OF THE OREGON HEALTHY CHILDREN CLUSTER BENCHMARKS -- 1991, 1993, 1995 BENCHMARK REPORTS
|
Benchmark |
1991 Report |
1993 Report |
1995 Report |
Data Sources |
|
HC1: Improve prenatal care |
Included as benchmark, not among priority benchmarks. % of mothers who receive adequate prenatal care was at 93% in 1990. Future Goals -- 1995: 98% 2000: 99% 2010: 100% |
Related benchmarks on improving overall access to health care. No future goals specified for prenatal care. |
Included as benchmark, not among priority benchmarks. Updated historic and target rates -- 1990: 76% 1995: 95% 2000: 95% 2010: 95% |
Based on number of live births to women who have prenatal visits beginning in the first trimester. From Oregon Health Division. |
|
HC2: Safe, affordable child care |
Included a series of related benchmarks. |
Included a series of related benchmarks. |
Included as series of related benchmarks. |
Tracks % if child care facilities that meet standards set by the state Child Care Division. |
|
HC3: Early Childhood Immunization |
Included as benchmark, not among priority benchmarks. Neither historic rates nor targets available. |
Continued as benchmark. Rate at 47% in 1992. Future Goals -- 1995: 80% 2000: 100% 2010: 100% |
Continued as benchmark. Historic rate updated to 53% in 1994. Future goals unchanged from 1993. |
Data from Oregon Health Division and the Childhood Immunization Directory. |
|
HC4: HIV among childbearing women |
Included benchmark on number of deaths attributed to AIDS. No benchmark on HIV among childbearing women. |
Included benchmarks on number of HIV cases and % of HIV cases with early diagnoses. No benchmark on HIV among childbearing women. |
Continued benchmarks on number of HIV cases and % of HIV cases with early diagnoses. No benchmark on HIV among childbearing women. |
State health statistics reported in Oregon HIV/AIDS Annual Report. |
|
HC5: Child abuse and neglect |
Included as benchmark, but not priority benchmark. 1990 rate was 12.3/1000. Future Goals -- 1990: 9.0/1000 2000: 6.0/1000 2010: 2.0/1000 |
Continued as benchmark, not among priority benchmarks. Future goals unchanged from 1991. |
Continued as priority benchmark. Future goals unchanged from 1991. |
Children's Service Division Administrative Files cites the number of children reportedly abandoned, abused or neglected. |
|
HC6: Teen pregnancy |
Included as priority benchmark. Pregnancy rate for teens was 19.5/1000 in 1990. Future Goals -- 1995: 9.8/1000 2000: 8.0/1000 2010: 8.0/1000 |
Continued as priority benchmark. Future goals unchanged from 1991. |
Continued as priority benchmark. Future goals unchanged from 1991. |
Tracks the number of live births and induced abortions for teen females. Cited in Oregon Vital Statistics. |
|
HC7: Early childhood development |
Included as priority benchmark. % of children entering kindergarten meeting development standards. Neither historic rates or future targets are provided. |
Continued as priority benchmark. Neither historic rates or future targets were provided. |
Continued as priority benchmark. Limited historic data reported. Future goals not yet set. |
Provided from the Oregon Early Childhood Development Assessment. |
|
HC8: Healthy birthweights |
Includes as benchmark, but not priority benchmark. Rate reported as 95% in 1980. Future Goals -- 1995: 96% 2000: 97% 2010: 98% |
Continued as benchmark, but not priority. Historic rates updated -- 95% in 1990 and 1992. Future goals unchanged from 1991 report. |
Continued as benchmark, but not priority. Future goals unchanged from 1991 report. |
Based on the number of infants who weight more than 5.5 lbs at birth divided by total number of live births. |
|
HC9: Infant mortality |
Not included in benchmarks. |
Included as benchmark. Infant mortality rate per 1000 was 8.8 in 1990. Target Goals -- 1995: 7.5/1000 2000: 6.0/1000 2010: 4.0/1000 |
Continued as benchmark, but not priority. Future goals unchanged from 1993 Report |
Oregon Vital Statistics Annual Report cites data on the number of infants who die within one year of birth. |
Criteria for evaluating the benchmarks from the Oregon Healthy Children Cluster are drawn from the principles of the Oregon Option and the methods used to select the Oregon Benchmarks. A summary review of the Oregon Healthy Children benchmarks is provided below. The chart on the following page and the Appendices contain additional details.
Link to Oregon Priorities: The Healthy Children Cluster benchmarks have long been identified as goals in the Oregon Benchmarks Reports. Most have also been adopted as statewide performance measures by the state Commission on Children and Families. The counterpart commissions on the county level have developed comprehensive plans that also use the state commission's core indicators.
Focus on Outcomes: Six of the nine Healthy Children benchmarks are focused on outcomes. The other three benchmarks -- prenatal care, child care access, and early childhood immunization -- are more directly related to outputs of services. In each case, however, these output indicators can be directly linked to outcomes that are priorities in Oregon. For example, there is a good chance that increasing the use of prenatal care and ensuring most children have completed their immunizations will increase the health and reduce sickness and death among babies and young children.
Engagement of and Endorsement by Stakeholders: The state and county Commissions on Children and Families include representatives from the community and from service delivery organizations. They also spearheaded public engagement efforts linked to both establishing the benchmarks and developing comprehensive plans.
Data Availability: Creative use of data has been a hallmark of the Healthy Children Cluster in 1996. The cluster helped to formulate a comprehensive data system to support improved planning and policy decisions in Oregon's decentralized system.(9) The State Commission on Children and Families worked with the U.S. Census Bureau, Clackamas County, and Portland State University to develop a system that can generate maps, data tables, and on-line access to information related to the Cluster benchmarks. Currently available for each of the state's counties, efforts are underway to link existing data files to map coordinates in a Geographic Information System. Map coordinates would be linked to recognizable and useful boundaries, enabling reporting or analyses of data at the county, city, school district, and zip code levels.
Future Goals: As of the 1995 benchmark report, future goals were adopted by the Progress Board for all nine Healthy Children benchmarks. Each provides an ambitious target. For example, the benchmarks call for increasing the percentage of two-year olds with complete immunizations from just under 50% in 1992 up to 80% in 1995 -- a goal Oregon has reached.
|
State Priority |
Outcome Measure |
Data Availability |
Ambitious Goal Compared to Historic Levels |
|
|
HC1: Prenatal care |
Included as benchmark in 1995. Related benchmarks in 1993, 1991. Linked to County Commission benchmarks. |
Output. |
State and county level data available. Developing subcounty-level reports. |
Target to increase from only 79% in 1990 to 95% in 1995 and beyond. |
|
HC2: Access to safe and affordable child care |
Included as benchmark in all three Reports. Linked to County Commission benchmark. |
Output. |
State and county level data available. |
Seeks to increase from 36% in 1993 to 90% in 1995 and 100% in 2000 and 2010. |
|
HC3: Immunization of two-year-olds |
Benchmark in 1993 and 1995. Linked to County Commission benchmarks. Goal of Immunization Consortium. |
Output. |
State and county data and maps available. Subcounty reports under development. |
Steady increase from 47% in 1992 to 53% in 1994. Targets 80% in 1995 and 100% in 2000 and 2010. |
|
HC4: HIV infection among childbearing women |
Included two related "urgent" benchmarks in 1993 and 1995. |
Outcome. |
State level data from HIV Program. |
Seeks to reverse increase in HIV infections. |
|
HC5: Child abuse and neglect |
Included as benchmark in 1991, 1993. Designated a priority benchmark in 1995. Linked to County Commission benchmark. |
Outcome. |
State and county level data available. |
Reverse recent trends of increasing rate to reduce from 10.5/1,000 in 1992 to 9 in 1995, 6 in 2000, and 2 in 2010. |
|
HC6: Teen pregnancy |
Included as priority benchmark in all three Reports. Linked to County Commission benchmark. |
Outcome. |
State and county data available and reported in map form. Subcounty reports under development. |
Rates dropped from 19.7 in 1990 to 17.9 in 1992. Goals are 9.8 in 1995, 8 in 2000, and 8 in 2010. |
|
HC7: Early childhood development |
Included as priority benchmark in all three Reports. Linked to County Commission benchmark. |
Outcome. |
State level data available. |
Future goals not quantified in 1995 Report. |
|
HC8: Healthy birthweights |
Included as benchmark in all three Reports. Linked to County Commission benchmarks. |
Outcome. |
State level data available. |
95% in 1990 and 1992. Target rates 96% in 1995, 97% in 2000, and 98% in 2010. |
|
HC9: Decrease infant mortality rate |
Included as benchmark in 1993 and 1995. Linked to County Commission benchmarks. |
Outcome. |
State level data available. |
Rate fell from 8.3 in 1990 to 7.1 in 1992. Target levels are 7.5 in 1995, 6.0 in 2000, and 4.0 in 2010. |
(1) Oregon Shines.
(2) Oregon Shines, page 24.
(3) HB2004, Oregon Legislature, 1993.
(4) "System Review Summary", Oregon Progress Board, December 1995.
(5) HB2004, Oregon Legislature, 1993.
(6) "Systems Review Summary", Oregon Progress Board, December 1995.
(7) Interview with Connie Revell, Oregon Option Director. May 1996.
(8) See "Child Health Data Pyramids", provided to the Community Partners by the Oregon Option Child Health Cluster, September 26, 1995.
(9) "Proposal for the Development of an Interactive Planning Data Mapping System", developed by Glen Rielly in early 1996. Provided by David Figeroa, Clackamas County GIS.