Topics on this page: Goal 3. Objective A | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary
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, 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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | Set Baseline | 20 states | 25 states | 29 states | 32 states | 35 states |
| Result | 17 states | 19 states | 27 states | Jan 30, 2015 | Jan 31, 2016 | Jan 31, 2017 |
| Status | Baseline | Target Not Met but Improved | Target Exceeded | Pending | Pending | Pending |
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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | Set Baseline | 23 % | 27 % | 26 % | 25 % | |
| Result | 25 % | 31 % | 23 % | Jan 31, 2016 | Jan 31, 2017 | |
| Status | Baseline | Target Not Met | Target Exceeded | Pending | Pending |
Maintain the proportion of youth living in safe and appropriate settings after exiting ACF-funded Transitional Living Program (TLP) services.50 (Lead Agency - ACF; Measure ID - 4.1LT and 4A)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 85 % | 86 % | 86 % | 86 % | 86 % | 87 % |
| Result | 87 % | 89.4 % | 87.7 % | 87.8 % | Dec 31, 2015 | Dec 30, 2016 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | N/A | 91.9 % | 91.7 % | 92.4 % | Prior Result +0.2PP | Prior Result +0.2PP |
| Result | 91.7 % | 91.5 % | 92.2 % | Oct 30, 2015 | Oct 31, 2016 | Oct 31, 2017 |
| Status | Historical Actual | Target Not Met | Target Exceeded | Pending | Pending | Pending |
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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | N/A | 73.3 % | 75.3 % | 75.4 % | Prior Result +0.5PP | Prior Result +0.5PP |
| Result | 72.8 % | 74.8 % | 74.9 % | Oct 30, 2015 | Oct 31, 2016 | Oct 31, 2017 |
| Status | Historical Actual | Target Exceeded | Target Not Met but Improved | Pending | Pending | Pending |
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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 80 % | 80 % | 80 % | 80 % | 84 % | 84 % |
| Result | 84.6 % | 85.3 % | 85.5 % | Oct 30, 2015 | Oct 31, 2016 | Oct 31, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending | Pending |
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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 13,051 | 4,930 | 6,457 | 4,84651 | 6,610 | 6,610 |
| Result | 6,639 | 6,357 | 6,610 | 6,280 | Dec 31, 2015 | Dec 31, 2016 |
| Status | Target Not Met but Improved | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending |
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)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | N/A | N/A | 76.1%52 | 76.1% | 65.9% | 65.9% |
| Result | 73.5% | 76.1% | 65.9% | 77.9% | Dec 31, 2015 | Dec 31, 2016 |
| Status | Historical Actual | Historical Actual | Target Not Met | Target Exceeded | Pending | Pending |
Decrease the percentage of middle and high school students who report current substance abuse (Lead Agency - SAMHSA; Measure ID - 3.2.30)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 20.0 % | 20.0 % | 20.0 %52 | 20.0 % | Discontinued | Discontinued |
| Result | 21.5 % | 19.1 % | 18.1 % | Results Unavailable | Discontinued | Discontinued |
| Status | Target Not Met but Improved | Target Exceeded | Target Exceeded | Results Unavailable | Discontinued | Discontinued |
Decrease the percentage of middle and high school students who report current alcohol use (Lead Agency - SAMHSA; Measure ID - 3.2.50)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 18.1 % | 18.1 % | ||||
| Result | Dec 31, 2015 | Dec 31, 2016 | ||||
| Status | Pending | Pending |
The number of children served by the Maternal and Child Health Block Grant. (Lead Agency - HRSA; Measure ID - 10.I.A.1)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 31 million | 33 million | 30 million | 31 million | 32 million | 34 million |
| Result | 37.4 million | 35.9 million | 34.3 million | Nov 30, 2015 | Nov 1, 2016 | Nov 30, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Pending | Pending | Pending |
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 has made this initiative a Priority Goal - 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. ACF has provided ongoing training and technical assistance to at least 30 states/territories on QRIS implementation; as of FY 2013, a total of 27 states had a QRIS that met high quality benchmarks, exceeding the target of 25 states. Currently, many states meet some, but not all seven, of the outlined benchmarks – for example, as of FY 2013, at least five states have incorporated six quality benchmarks and at least seven states have incorporated five 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 2014 indicates that 23 percent of grantees scored in the low range, exceeding the target of 27 percent. Seven of eight FY 2014 implementation milestones for this program are completed and one is ongoing.
ACF is committed to establishing permanency for some of our most vulnerable citizens—children who are in foster care and runaways. The Transitional Living Program (TLP) seeks to foster a safe and appropriate exit rate of children from the program, which is 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, TLPs 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 exceeded its ambitious target in FY 2013 for those children in care less than 24 months, finding permanency for 92.2 percent. Because of the challenges related to placing those children in established living situations after longer than 24 months, ACF fell slightly short of its target for FY 2013, realizing permanency in 74.9 percent of exits. 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 2013, performance on this measure again improved from the previous year with 85.5 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. Despite a decline of less than 10 percent from FY 2013, in FY 2014 the number of children with severe emotional disturbance that are receiving services from the CMHI 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 2014, SAMHSA exceeded the performance target with 77.9 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.
The Youth Violence Prevention initiative implemented enhanced, coordinated, and comprehensive activities, programs, and services that contributed to healthy childhood development, as well as preventing violence and alcohol and drug abuse. Progress was measured in several ways, including tracking the reported rate of current substance abuse among middle and high school students. Performance for this activity was stable and the program was deemed successful. The Youth Violence Prevention initiative is being transitioned into a new coordinated effort to address these important and complex problems called the Safe Schools Healthy Students State and Tribal program. Due to this transition, the performance and accountability plan is being updated. Data is no longer available for the Youth Violence Prevention program but will be soon available for the Safe Schools Healthy Students State and Tribal program.
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 will continue to have aggressive targets and aim to improve results in order to lay a stronger foundation for each child’s future through strengthening the quality of early childhood education programs. ACF continues to invest in building its 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, using a case management approach. ACF will conduct more analysis on the specific dimensions that are particularly challenging for those grantees and develop a process for working more directly with those grantees on strategies for improvement. States are also making significant progress toward implementing a comprehensive QRIS that meets all outlined quality benchmarks; however, their progress is masked by the single figure reported. To provide a more complete picture of QRIS implementation and improvements across the country, OCC is closely tracking the progress of states that may not meet all quality benchmarks, but that have demonstrated improvements by increasing the number of benchmarks reached.
ACF will continue to support state agencies as they work to move children to permanent homes and anticipates that the FY 2016 performance for placement in less than 24 months will be 0.2 percentage points higher than the previous year's performance. Although there was a slight decrease in performance this fiscal year for placement of children who had been in foster care greater than 24 months, ACF anticipates improvement on this measure, and by FY 2016 expects that it will show an increase of 0.5 percentage points from the previous year's actual performance. Given the recent data trend, ACF increased the future year target for the percent of children experiencing no more than two placement settings in the first year of foster care to 84 percent in fiscal years 2015 and 2016. 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.
SAMHSA continues to support the CMHI through grants to support states, regions within states, the District of Columbia, Territories, Native American Tribes and tribal organizations, in developing integrated home and community-based services for children and youth with serious emotional disturbances as well as support for their families. SAMHSA continues to encourage the development and expansion of the effective and enduring strategic approach to mental health care termed “systems of care.” SAMHSA expects high performance during FY 2015.
NCTSI grantees continue to implement Evidence Based Practices (EBPs) that improve behavioral health treatment, services, and interventions for children and adolescents exposed to traumatic events. The service providers of many grantees were trained in FY 2013 and are learning new interventions. As grantees continue to gain experience and knowledge and providers expand their capacity to provide trauma-informed services, the rate of positive functioning at 6 month follow-up will increase.
SAMHSA will continue to support healthy childhood development, prevent violence, and prevent alcohol and drug abuse through the Safe Schools Healthy Students (SS/HS) State and Tribal program. The SS/HS initiative works to decrease violence while increasing the number of students who receive mental health services. SS/HS supports school and community partnerships by encouraging integrated systems that promote students’ mental health, enhance their academic achievement, prevent violence and substance use, and create safe and respectful school climates. SAMHSA will be replacing measure 3.2.30 (Youth Violence Prevention) with measure 3.2.50 (SS/HS) in FY 2015. The new measure tracks the success of this program in part through the percentage of middle and high school students who report current alcohol use.
Improving the health of mothers, children, and their families is the mission of HRSA’s Maternal and Child Health Block Grant program. HRSA’s targets for FY 2014-2016 reflect expectations regarding service mix and state and federal funding levels.
Objective Progress Update Summary
HHS demonstrated progress toward this objective as shown by the representative performance measures described in the HHS Annual Performance Plan and Report. Further evidence of progress is described below.
- ACF tracks the developmental progress of successive cohorts of nationally representative samples of 3 to 4-year-old children newly entering Head Start in the fall of the program year. Data from the last cohort showed that children assessed in English demonstrate progress toward norms across all developmental areas assessed between the fall and spring. Children assessed in Spanish make progress towards norms in the area of letter-word knowledge. Children also demonstrated gains in executive functioning skills by the end of the program year, and both teachers and parents report that children show growth in their social skills during their first Head Start year. Teachers rate children as having fewer problem behaviors by the spring, including hyperactive behaviors, as well as more positive approaches to learning.
- An issue of paramount concern for the disability community and a focus for Protection and Advocacy Agencies (P&A) that receive ACL funding is the prevention, reduction and ultimate elimination of the use of restraint and seclusion on school children. Over 62 percent of P&A clients are children or young adults between ages 5 and 22. In FY 2013, nearly 64 percent of all P&A cases addressed issues related to abuse and neglect and in the area of education. In FY 2012 nearly 78 percent of individuals' case files (for all issues) were closed due to the P&A resolving the issue in the individuals favor. Only 2% of cases were closed due to unsuccessful appeals.
- A 3-year study assessed the performance of training, research, and state systems grant programs in meeting the objectives of the Combating Autism Act Initiative. The study found increases in the number of children receiving diagnostic evaluations over the course of the grant period, thereby providing an early indication of progress toward reducing barriers to services.
- Spinal muscular atrophy (SMA) is a genetic disease that weakens muscles and can affect walking, crawling, breathing, swallowing and head and neck control. Early treatment is critical; however, the short window of opportunity often occurs before symptoms appear. NIH-supported researchers developed an inexpensive and quick DNA test that could be used shortly after birth to identify newborns at risk of developing SMA.
- SAMHSA’s SS/HS initiative has successfully decreased violence and increased the number of students receiving mental health services. For elementary, middle, and high schools participating in the SS/HS grant program, there were significant increases in the proportion of students receiving school-based mental health services. Participating elementary and middle schools reported decreased problems with gang activity. Among students at participating high schools, there were significant reductions in 30-day alcohol use.
The Department is continuing to support and execute the programs contributing to this objective, monitoring progress, performance, and program integrity while adjusting to any budgetary constraints or changes to programmatic demands.
50 The language of this performance measure has been updated from “increase” to “maintain” to be consistent with future performance targets and the most recent data trend.
