FY 2017 Annual Performance Plan and Report - Goal 3 Objective A

Topics on this page: Goal 3. Objective A | Table of Related Performance Measures | Analysis of Results | Plans for the Future | FY 2014 Strategic Review Objective Progress Update Summary

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Goal 3.  Objective A:  Promote the safety, well-being, resilience and healthy development of children and youth

Children and youth depend on the adults in their lives to keep them safe and to help them achieve their full potential.  Yet too many of our young people—our nation’s future workforce, parents, and civic leaders—are at risk of adverse outcomes. 

HHS partners with state, local, tribal, urban Indian, and other service providers to sustain an essential safety net of services that protect children and youth, promote their resilience in the face of adversity, and ensure their healthy development from birth through the transition to adulthood.  Health and early intervention services ensure children get off to a good start from infancy.  Early childhood programs, including Head Start, enhance the school readiness of preschool children.  Child welfare programs, including child abuse prevention, foster care, and adoption assistance, target those families in which there are safety or neglect concerns.  Services for children exposed to trauma or challenged with mental or substance use disorders provide support for those with behavioral healthcare needs.  Several HHS programs also promote positive youth development and seek to prevent risky behaviors in youth.  Vital research funded by agencies across HHS seeks to understand the risks to children’s safety, health, and well-being and to build evidence about effective interventions to mitigate these risks. 

A wide range of HHS agencies support these activities, including ACF, ACL, CDC, HRSA, NIH, OASH, and SAMHSA.  Below are several performance measures used by HHS agencies to manage performance and ensure the safety and well-being of children and youth.  The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.

Objective 3.A Table of Related Performance Measures

Increase the number of states that implement Quality Rating and Improvement Systems (QRIS) that meet high quality benchmarks (Lead Agency - ACF; Measure ID - 2B)

Reduce the proportion of Head Start grantees receiving a score in the low range on the basis of the Classroom Assessment Scoring System (CLASS: Pre-K). (Lead Agency - ACF; Measure ID - 3A)

Increase the percentage of Head Start and Early Head Start teachers that have a BA or higher. (Lead Agency - ACF; Measure ID - 3D)

 Maintain the proportion of youth living in safe and appropriate settings after exiting ACF-funded Transitional Living Program (TLP) services. ¹  (Lead Agency - ACF; Measure ID - 4.1LT and 4A)

Of all children who exit foster care in less than 24 months, increase the percentage who exit to permanency (reunification, living with relative, guardianship or adoption) (Lead Agency - ACF; Measure ID - 7P1)

Of all children who exit foster care after 24 or more months, increase the percentage who exit to permanency (reunification, living with relative, guardianship or adoption).  (Lead Agency - ACF; Measure ID - 7P2)

For those children who had been in foster care less than 12 months, maintain the percentage that has no more than two placement settings.  (Lead Agency - ACF; Measure ID - 7Q)

Increase the number of children with severe emotional disturbance that are receiving services from the Children's Mental Health Initiative (Lead Agency - SAMHSA; Measure ID - 3.2.16)

Increase the percentage of children receiving trauma informed services who report positive functioning at 6 month follow-up (Lead Agency - SAMHSA; Measure ID - 3.2.02a)

Decrease the percentage of middle and high school students who report current alcohol use (Lead Agency - SAMHSA; Measure ID - 3.2.50)

The number of children served by the Maternal and Child Health Block Grant.  (Lead Agency - HRSA; Measure ID - 10.I.A.1)

Analysis of Results

Strengthening the quality of early childhood education programs can provide a stronger foundation for each child’s future.  Because improving the quality of Head Start and Child Care programs will help achieve a more solid foundation for each child, HHS made this initiative a Priority Goal  for the FY 2014 – 2015 period and continued for FY 2016 –2017: to improve the quality of early childhood programs for low-income children through implementation of the Quality Rating and Improvement Systems (QRIS) in the Child Care and Development Fund and through implementation of the Classroom Assessment Scoring System (CLASS: Pre-K) in the Head Start program.  For the ACF Child Care program, the goal is to increase the number of states with a QRIS that meets the seven high quality benchmarks developed by HHS in coordination with the Department of Education for child care and other early childhood programs.  As of FY 2014, 29 states had a QRIS that met high quality benchmarks, meeting the previously established target.  States expanded from pilot programs to statewide-systems and increased availability to quality information, leading them to meet more components of the QRIS measure.  States were also supported by targeted technical assistance through state specific benchmarks and goals.  The FY 2014 results show that states continue to make progress toward implementing QRIS that meet high-quality benchmarks.  Currently, many states meet some, but not all seven, of the outlined benchmarks – for example, as of FY 2014, at least six states have incorporated six quality benchmarks and at least six states have incorporated five quality benchmarks.  In addition, targeted technical assistance provided by the new National Center on Early Childhood Quality Assurance, as well as other technical assistance partners funded by OCC, helps states work toward their goals to improve their QRIS through small group peer-to-peer interactions, national webinars, and topical learning tables related to quality benchmarks. 

The ACF Office of Head Start completed a comprehensive data collection effort and analysis of a full program year of CLASS: Pre-K data as part of an ongoing effort to improve training and assistance, and thus enhance children’s school readiness.  In support of this effort, ACF is measuring the proportion of Head Start grantees that score in the low range on any of the three domains of the CLASS: Pre-K.  An analysis of CLASS scores for FY 2015 indicates that 22 percent of grantees scored in the low range, exceeding the target of 26 percent.  All grantees scoring in the low range did so on the Instructional Support domain.  All seven FY 2015 implementation milestones for this program were also completed.

In addition to looking at classroom quality through the CLASS measure, the ACF Office of Head Start (OHS) is also emphasizing the credentials of classroom teachers by striving to increase the percent of Head Start and Early Head Start teachers with a Bachelor’s Degree (BA) degree.  In doing so, OHS is prioritizing a distinct but complementary goal in boosting the quality of Head Start programs.  This measure is distinct in that it looks at credentials for both Head Start and Early Head Start teachers, rather than focusing on the credentials of Head Start pre-school teachers.  The most recent results for this performance measure indicate that in FY 2015, 60 percent of Head Start and Early Head Start teachers have a BA or higher. 

ACF is committed to establishing permanency for some of our most vulnerable citizens—children who are in foster care and runaways.  The ACF Transitional Living Program (TLP) seeks to foster a safe and appropriate exit rate of children from the program by monitoring the percentage of TLP youth (aged 16-21) discharged during the year who find immediate living situations that are consistent with independent living.  During FY 2014, the TLP exceeded the 86 percent target for this performance measure by attaining an 87.8 percent safe exit rate.  Performance improvements were achieved through ACF's promotion and support of innovative strategies that help grantees:  (1) encourage youth to complete the program and achieve their developmental goals instead of dropping out, (2) stay connected with youth as they transition out of program residencies and provide preventive, follow-up and after care services, (3) track exiting youth more closely and stay connected, (4) report accurate data and maintain updated youth records to reduce the number of youth whose exit situations are unknown, and (5) analyze data to discover patterns and opportunities.

ACF has a suite of performance measures focused on ensuring positive permanent living situations for children in foster care, while ensuring children are placed in safe living arrangements.  Establishing permanency for children who are in foster care is a priority for ACF since children who remain in care for longer periods of time are less likely to exit to permanency and experience the benefits of stable living arrangements.  ACF fell short of its target in FY 2014 (92.4 percent) for those children in care less than 24 months, finding permanency for 91.6 percent.  ACF also fell slightly short of its target for FY 2014 (75.4 percent) on the complementary performance measure examining the placement rate for children who have been in care 24 months or longer, realizing permanency in 75.0 percent of exits, but nonetheless demonstrated improvement over the previous year’s rate.  Trauma can be aggravated further when a child is moved from one placement setting to another; therefore ACF strives to have no more than two placement settings during the first 12 months of foster care.  In FY 2014, performance on this measure declined slightly from the previous year (85.5 percent), but still exceeded its target with 85.2 percent of children experiencing no more than two placements in the first year of foster care.

In support of individuals, families, schools, and other organizations throughout the community, SAMHSA is promoting emotional health and preventing mental illness and substance abuse in children and adolescents.  The Child Mental Health Initiative (CMHI) is designed to promote the transformation of the national mental health care system that serves children and youth (aged 0 to 21 years) diagnosed with a serious emotional disturbance and their families.  This occurs through the development of comprehensive, community-based services that target children and youth dealing with serious emotional disturbance (SED) and other issues.  CMHI funds the development and implementation of comprehensive and coordinated ― systems of care among states, local communities, United States territories, and American Indian/Alaska Native Tribal Nations.  These family-driven systems of care build on the individual strengths of the children, youth, and families being served, and address their needs.  In FY 2015, the number of children with severe emotional disturbance that are receiving services from the CMHI increased and the measure exceeded the target.

SAMHSA’s National Child Traumatic Stress Initiative (NCTSI) is designed to improve behavioral health treatment, services, and interventions for children and adolescents (as well as their families) who have been exposed to traumatic events.  NCTSI provides training and technical support for interventions that reduce the mental, emotional, and behavioral effects of trauma.  This program continues as a principal and long-standing source of child trauma training for our nation.  In FY 2015, SAMHSA exceeded the performance target with 74.4 percent of children who received services showing positive functioning at 6 months follow-up.  Positive functioning refers to an overall ability to perform routine life activities.  Positive functioning associates psychological as well as social, emotional, and psychological well-being.  As a growing number of service and clinical providers develop their capacity to provide trauma-informed services, the rate of positive functioning at 6 month follow-up is expected to increase. 

SAMHSA's Safe Schools Healthy Students (SS/HS) seeks to create healthy learning environments that help students thrive, succeed in school and build healthy relationships.  The program addresses key public health priorities associated with youth in the US.  This program implements and continually improves a coordinated and comprehensive plan of activities, programs, and services that promote healthy childhood development, prevent violence, and prevent unhealthy behaviors.  Grantees are required to develop local strategic plans that address five required elements: (1) safe school environments and violence prevention activities; (2) alcohol, tobacco, and other drug prevention activities; (3) student behavioral, social, and emotional supports; (4) mental health services; and (5) early childhood social and emotional learning programs.  This measure includes both middle school and high school students that reported having used alcohol within the past 30 days.  For this measure, lower numbers reflect higher performance.  In FY 2015, 25 percent of middle and high school students who report current alcohol use, exceeding the target.

HRSA’s contribution to this objective also includes the Maternal and Child Health (MCH) Block Grant Program, which serves vulnerable populations by seeking to improve the health of all mothers, children, and their families.  In FY 2013, 34.3 million children were served by the Block Grant program.

Plans for the Future

ACF continues to invest in building its Classroom Assessment Scoring System (CLASS) related resources and making those resources available to grantees.  In response to the data from the FY 2013 CLASS reviews, ACF plans to provide more intentional targeted assistance to those grantees that score in the low range on CLASS.  ACF will conduct more analysis on the specific dimensions that are particularly challenging for those grantees, such as concept development and language modeling, and tailor the technical assistance for grantees based on their specific needs.  With respect to increasing the number of teachers with a Bachelor’s Degree (BA) or higher, ACF is investing in an initiative called Early EdU, which is a higher education alliance working to advance early childhood teaching by providing online courses for early childhood educators so they can pursue a BA.  ACF is also working within states to strengthen early care and education professional development systems and promote articulation agreements within and across institutions of higher education.  Articulation agreements allow students to apply credits earned in one program toward another program, which facilitates them moving along their educational pathway toward a BA.  The ACF Office of Child Care (OCC) is gathering information about Quality Rating and Improvement System (QRIS) implementation through the Child Care and Development Fund (CCDF) Plan and the annual quality performance report, as well as providing states with targeted technical assistance through state specific technical assistance plans and goals.  The National Center for Child Care Quality Improvement, funded by OCC, helps states work toward their goals to improve their QRIS through small group peer-to-peer interactions, national webinars, and topical learning tables related to quality benchmarks.

ACF will continue to support state agencies as they work to move children to permanent homes.  ACF is providing technical assistance to the states to improve placement stability for children in care, and states are employing a number of strategies, including increasing the use of relatives as placement resources and improving training and support for foster parents to improve retention and prevent placement disruptions.

 As part of the Maternal and Child Health (MCH) Block Grant Program, HRSA will continue to  address states’ efforts  to strengthen the capacity and quality of health systems to serve women, infants, and children support of health systems infrastructure development, public information and education, screening and counseling, and other services (including direct care services as payer of last resort).  In addition, the Program will continue to monitor emerging issues, provide needed technical assistance , and share promising models and effective strategies that promote improved maternal and child health outcomes.

The Safe Schools Healthy Students (SS/HS) initiative addresses key public health priorities associated with youth in the US.  This program includes Project Aware.  SS/HS is designed to implement and continually improve a coordinated and comprehensive plan of activities, programs, and services that promote a healthy learning environment where students thrive, succeed in school, and build healthy relationships.  SAMHSA is taking this effective model to scale through the Safe Schools/Healthy Students State Planning, Local Education Agency, and Local Community Cooperative Agreements.  The State Education Agency and the State Mental Health Authority are partners in the oversight.  The intent is to build cross system capacity to utilize effectively the growing body of knowledge learned from prevention and implementation science for the purpose of supporting expanded adoption of similar approaches in states. 

In FY 2014, in response to the tragedy at Sandy Hook Elementary School and as part of the President’s Now is the Time initiative, SAMHSA provided resources to support Project AWARE (Advancing Wellness and Resilience in Education) in order to increase awareness of mental health issues and connect young people who have behavioral health issues and their families with needed services.  SAMHSA collaborates with the Departments of Education and Justice in the development, implementation, and management of this initiative to maximize coordination and avoid duplication of efforts.  Project AWARE has multiple components.  The first component, Project AWARE State Educational Agency (SEA) grants, is built on the highly successful SS/HS model.  This model seeks to create safe and supportive schools and communities.  SAMHSA has awarded these grants to 20 SEAs to promote comprehensive, coordinated, and integrated state efforts to make schools safer and increase access to mental health services. 

FY 2014 Strategic Review Objective Progress Update Summary

Please note that this section summarizes the result of the FY 2014 HHS Strategic Review process, limiting the scope of content to that available prior to spring of 2015.  Due to this constraint, the following may not be the most current information available.

Conclusion:  Progressing

Analysis:  HHS collaborates with state, local, tribal, urban Indian, nongovernmental, and private sector partners to sustain an essential safety net of services that protect children and youth, promote their emotional health and resilience in the face of adversity or trauma, and ensure their healthy development from birth through the transition to adulthood.  In a number of cases there was substantial evidence of important innovation and impact, with systematic evaluation of efforts and outcomes.  Significant trends include increased attention to specific causal areas of risk --for example, early identification of developmental delay and increased attention to the biopsychosocial effects of trauma and adverse childhood experience.  There was evidence of major policy development efforts, and substantial evidence of serious engagement in evaluation.

The Institute of Medicine has highlighted many opportunities for improving adolescent health.  Adolescent Health: Think, Act, Grow (TAG) was developed to build awareness of the adolescent years as opportunities to increase delivery of recommended screening, immunizations, and other recommended preventive services; to intervene promptly when risky behavior, mental health, substance use, or other issues emerge; and to set the course for healthy, productive adulthood.

In 2014, the President signed into the law the first statutory reauthorization of the Child Care and Development Block Grant (CCDBG) program since 1996, which aims to move children receiving subsidies into high-quality child care settings.  Among a comprehensive array of reforms, the new statute includes an increased focus on improving the quality of child care through systemic quality investments, which will helps states toward meeting the Priority Goal.  In addition, the statute includes provisions requiring states to evaluate the measurable outcomes of their quality improvement activities.

Several key changes have been made to the Teen Pregnancy Prevention (TPP) Program based on experiences during the last five years, lessons learned, and feedback from experts in the field. Changes in the new funding for grantees includes, but is not limited to, ensuring inclusivity of all youth served, applying Positive Youth Development practices when interacting with youth, and using a trauma-informed approach.

As HHS increasingly focuses on preventive interventions, the problem of how to measure and demonstrate success will require additional attention.  For example, there are 50,000 Head Start and Early Head Start classrooms across the country in diverse settings ranging from New York City to the bottom of the Grand Canyon.  Changing teacher behavior and practices at the ground level to improve the quality of the classroom is a formidable challenge, particularly in highly rural areas, American Indian and Alaska Native programs, and Migrant and Seasonal Head Start programs where finding qualified staff can be difficult due to more limited access to higher education. 

Among the major planned efforts for the Department is the continued implementation of an action plan for the Priority Goal for improving Early Childhood Care and Education.  In addition, the Department will be working among Divisions to identify reimbursement mechanisms for trauma-informed and trauma-focused care interventions with children.

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