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ACCESS TO CARECURRENT AND FUTUREPLANNING EFFORTSThe percent of adults with a personal doctor,or usual primary care provider, is an extremelyimportant metric relating to health access,personal health and overall public health.Better access to care leads to better healthbehaviors and better health outcomes. Therecently enacted federal health care bill(Patient Protection and Affordable Care Act)is improving matters relating to health access,but to what extent and what speed is unclear(2013 is the latest year in which BRFSS data isavailable.)NOTE: The current Palm Beach CountyCommunity Health Improvement Plan (CHIP) hasa focus on expanding access to care, but uses adifferent indicator: Decrease the percentage ofuninsured population in Palm Beach County. Thismeasure is available annually from US Censusestimates, while BRFSS data is available onlyevery three years. Here is some recent data(2015 data should be available Fall 2016):Some measures that need to be taken toachieve the overall goal are listed below:UNINSURED POPULATION: AMERICAN COMMUNITY SURVEY DATA25.0%20.0%15.0%Palm Beach arPalm Beach 6.3%16.6%11.7%Navigators at FQHCs and other agenciesFunding from local foundationsɟɟ Additional funding from other sourcesɟɟɟɟ12A REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 2017

ACCESS TO CAREMAJOR DISPARITIESBehavioral Risk Factor Surveillance System(BRFSS) data shows disparities between races/ethnic groups among percentages of adultswho have a personal doctor. In 2010 in PalmBeach County, while 86.6% of non-HispanicWhites had a personal doctor, only 74.6% ofnon-Hispanic Blacks had a personal doctor.2010 data for Hispanics wasn’t available. Thisdisparity continued into the 2013 BRFSS. In 2013CHART 1 R EVENUE SOURCES FOR OUTPATIENT UNINSURED/UNDERINSUREDPOPULATION IN PALM BEACH COUNTY 4,456,573 5,663,786 2,321,427 308,000 14,858,551 49,854,337 59,329,000 196,974 1,371,287 48,331,979DOH State RevenueFederal HRSA Grants - FQHCUnited WayRyan White Funding: Palm Beach CountyHealth Care District - Combined Children's Health, Funding Collaboratives, and Managed Care (Outpatient Only)Medicaid Claims: Physician MD/DOMedicaid Claims: Podiatrist/ChiropractorMedicaid Claims: Mid -Level & DentistMedicaid Claims: Federally Qualified Health CenterMedicaid Claims: Case Management AgencySource: Health Care District: Comprehensive Annual Financial Report for fiscal year endedSeptember 30, 2009. Health Statistics and Assessment - Florida Department of Health and US Departmentof Health and Human Services - Centers for Medicare and Medicaid Services Fee-for-Services (FFS) DataA REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 201713

ACCESS TO CAREin Palm Beach County, while 84.6% of nonHispanic Whites had a personal doctor, only69.5% of non-Hispanic Blacks and 66.1% ofHispanics had a personal doctor.90%TABLE 1 ADULTS WHO HAVE A PERSONALDOCTOR88%86%84%82%80%“For a healthy life, there’s noplace like a medical home!”78%76%74%–Alina Alonso, MDDirectorPalm Beach County Health DepartmentREPORT HIGHLIGHTSɟɟThe Healthy People 2010 goal of 85% percentpeople with a usual primary care provider wasnot met at the County, State or National level.ɟɟPalm Beach County ranked 10th of 67 Floridacounties in the category of clinical care, and 19thof 67 Florida counties in the category of social &economic factors. Source: 2016 Robert WoodJohnson County Health RankingsɟɟPalm Beach County had a primary care providerrate of 1270:1, better than the Florida rate of1390:1. Top US performers had a rate of 1040:1.Source: 2016 Robert Wood Johnson County HealthRankings72%70%20022007U.S.A.78%78%Palm Beach %85%85%TABLE 2 P ALM BEACH COUNTY HEALTH DEPARTMENT REVENUE SOURCESFOR PRIMARY CARE AT THE FWHC CLINICSREVENUE:TOTAL FY 08 09HRSA (Section 330 Grant) 2,321,427Health Care District - Block Grant 2,021,094State Program Revenues Incl. Fed Funds 910,775Medicare 246,856Medicaid 4,028,770Health Insurance - HCD, HPB, Humana, Etc. 1,745,020Patient FeesLocal Grants or Donations (Ryan White)Transfers From Health Dept. (State GR)TOTAL142010 503,870 610,595 4,753,011 17,141,418Source:PBCHD Financeand AccountingA REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 2017

ACCESS TO CARETABLE 3 PALM BEACH COUNTY ADULTS WHO HAVE A PERSONAL 02013Non-Hispanic White82.90%86.10%86.60%84.60%Non-Hispanic on-Hispanic WhiteNon-Hispanic Black66.10%HispanicA REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 201715

ACCESS TO CARETABLE 4 U NINSURED POPULATION: AMERICAN COMMUNITY SURVEY DATAFROM THE U.S. CENSUS BUREAU25.0%20.0%15.0%Palm Beach 9.4%Palm Beach County16A REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 2017

CHILDCARE/AFTERSCHOOL CAREKEY INDICATORGOALThe Key Indicator for Child and AfterSchool Care is measured by theannual average number of children onthe waiting list for subsidized care.Reduce the number of childrenawaiting subsidized child care inPalm Beach County.A REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 201717

CHILDCARE/AFTERSCHOOL CARECURRENT AND FUTUREPLANNING EFFORTSThe waiting list for subsidized child care hasproven not to be an accurate measure ofhow well the need for child care is being met.The fact that the wait list is so large, andconsequently the time it takes to receiveservices is so long, means that many eligiblefamilies do not apply at all. For example, inDecember 2015, the wait list was actuallyreduced to 0, and by April 2016, it was back upto 4,500. So, while the number of children onthe wait list has remained over 1,000 since thelast Indicator Report update, the number ofchildren receiving subsidized child care hasincreased by almost 4,000, mostly due to localfunding from the Children’s Services Council.Currently, the Florida Department of Healthmonitors all licensed child care programs whichincludes most school readiness programs toensure adherence to the minimum operationalstandards. The Early Learning Coalitionmonitors both school readiness and voluntarypre-k programs to ensure that requirementsare met as established by Florida’s Office ofEarly Learning.Child Care quality is one of the criticalcomponents of school readiness. In 2015,Children’s Services Council revised their Quality18Rating and Improvement System (QRIS) andlaunched the Strong Minds Network. TheStrong Minds Network provides resources suchas quality assessments, training and professionaldevelopment, technical assistance and financialsupplements to increase capacity of qualitychild care programs in Palm Beach County.There are currently 258 child care programsparticipating. 227 of those child care programshave achieved quality status. An evaluation iscurrently underway.In order to measure quality child careenvironments in a way that is valid andreliable, the Strong Minds Network usesmultiple assessment tools that measure bothenvironment quality and the quality of theteacher/child interactions. The ClassroomAssessment Scoring System (CLASS)are observation tools that focus on theeffectiveness of classroom interactions amongthe teachers and children. The EnvironmentRating Scale (ERS) are observation tools thatassess process quality in early childhoodsettings. Process quality consists of thevarious interactions that go on in a classroombetween staff and children, staff, parents, andother adults, among the children themselves,and the interactions children have with themany materials and activities in the child careenvironment.“Many low-incomefamilies on waiting listsare forced to use carethat is unreliable or ofpoor quality becausethey cannot affordbetter options withoutassistance, strain to payother bills in order topay for child care, orhave difficulty keepingtheir jobs because theycannot afford care,according to severalstudies.”Source: Schulman & Blank(September 2007)State Child Care AssistancePolicies 2007: Some StepsForward, More Progress Needed,National Women’s Law Center,Issue BriefA REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 2017

CHILDCARE/AFTERSCHOOL CAREOver the years, local, state and national supportfor improvement in the quality of early care andeducation has grown tremendously. Throughdiverse partnerships, stakeholders are comingtogether to identify those components essentialin building early childhood quality that willpositively impact the lives of young children.The majority of states in the country areoperating a statewide QRIS. Florida does nothave a statewide system; however, there aremany local QRIS systems.Fostering high quality in out-of-school timeprograms, which provide opportunities forchildren and youth to succeed, is the mission ofPrime Time Palm Beach County, a nonprofitintermediary organization that servesafterschool programs and practitioners. Theyprovide supports and resources that increaseprogram quality to positively impact school-ageyouth. Prime Time provides a set of qualitystandards, a system for reaching thesestandards through assessment, technicalassistance and resources, as well as a broad anddiverse range of program enhancements toafterschool providers.Early care and after-school professionaldevelopment system:Research links higher qualifications ofearly childhood and afterschoolCHART 2 FUNDING IN PALM BEACH COUNTY - FY 2016School Readiness31%36%Voluntary PrekindergartenEducation ProgramChild Care ExecutivePartnership Program4%Other Local Revenues29%Program FundsAmountSchool Readiness Funds 33,558,738Voluntary Prekindergarten Education Program Funds 27,269,164Child Care Executive Partnership Program FundsOther Local RevenuesA REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 2017 3,893,014 29,290,84519

CHILDCARE/AFTERSCHOOL CAREpractitioners to better learningenvironments and outcomes for children.Practitioners are encouraged to obtaintraining and education in order to providehigh-quality programs for children.ɟɟQuality information training and formal/creditcollege classes focused in early childhood, andout of school time are available;ɟɟScholarships, salary supplements and careeradvising support career pathways;ɟɟRegistry – system and database which documentsand recognizes practitioner achievement ineducation, training, and professionaldevelopment; provides quality assurance fortrainers and trainings; informs ongoingcommunity professional development andplanning initiatives;ɟɟCareer pathway – supports practitionerprofessional growth through the dual routes ofinformal, formal and hybrid education plans.The Early Learning Coalition intends tocontinue working with early care and educationsystem partners to develop a centralized waitlistin order to have a more accurate picture ofchild care needs in Palm Beach County.The Coalition is working with the Children’sServices Council to determine child care needs20“Parents who are concernedabout their children’s afterschool care miss an averageof five extra days of workper year, which is estimatedto cost employers 496 to 1,984 per employee peryear depending on theemployee’s annual salary.”–Community, Families and Work Programat Brandeis University, 2005in each zip code in Palm Beach County. This willhelp determine areas of highest need and childcare availability in those areas.MAJOR DISPARITIESSome of the issues regarding use of waitlistdata to describe the need for child care are:ɟɟThe waitlist is self-reported and may not be anaccurate representation of child care need.ɟɟThe current waitlist does not include all early careand education partners and therefore does notA REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 2017

CHILDCARE/AFTERSCHOOL CAREprovide an accurate picture of child caresubsidy needs.ɟɟREPORT HIGHLIGHTSɟɟThe indicator focuses on need and availabilityof child care; efforts should also focus on qualityto ensure children are adequately preparedfor kindergarten.ɟɟWaitlist data provides only a piece of the pictureof subsidized child care. Future work is needed toaddress reasons for fluctuations, assess bothneed and supply, especially in hard-to-reach-andserve populations and develop a centralizedwaiting list that is all-inclusive.The Early Learning Coalition continues towork with the Children’s Services Council ofPalm Beach County to research and evaluatethe delivery of quality child care services inthe community.TABLE 5 NUMBER ON SUBSIDIZED CARE WAITING80,00070,000Raw ,61428,901Palm Beach County3,9686,8561,1294,1427,2404,092Average of 6 largest counties in Florida7,1399,3006,5234,2466,0352,976A REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 201721

DOMESTIC ABUSE/SHELTERINGKEY INDICATORGOALThe Key Indicator for DomesticAbuse Violence is the domestichomicide rate for Palm Beach County.Reduce the number of domestic-related homicidesin Palm Beach County.Note: Ideally, the goals would be to have no domesticrelated homicides; however, this may be unrealistic, so thegoal should be to have the number be at or below theaverage number of homicides compared to counties ofsimilar size and demographics.A REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY – BASED ON KEY COMMUNITY INDICATORS 201723

DOMESTIC ABUSE/SHELTERINGCURRENT STATUSWho is Doing What to Whom– NationalCoalition Against Domestic ViolenceDomestic violence, also known as IntimatePartner Violence, is an extremely complicated,multi-faceted issue. Studies widely identifywomen as victimized more often than men bytheir intimate partners, but men can be victimsof intimate partner violence, too, and womenmay use violence within relationships. What isoften harder to determine, especially whenboth people in a relationship use violence, iswho may be the core abuser and who may bethe primary victim.Abusers' main objective in intimate relationshipsis to dominate and control their victim. Theyare manipulative and clever and will use amyriad of tactics to gain and maintain controlover their partner, often in cycles that consistof periods of good times and peace and periodsof abuse. The cycle often starts to repeat,commonly becoming more and more intense astime goes on. Each relationship is different, andnot every relationship follows the exact pattern.Some abusers may cycle rapidly, others overlonger stretches of time. Regardless, abuserspurposefully use numerous tactics of abuse toinstill fear in the victim and maintain controlover them.24Anyone can be a victim of domestic violence.There is NO “typical victim.” Victims ofdomestic violence come from all walks of life,varying age groups, all backgrounds, allcommunities, all education levels, all economiclevels, all cultures, all ethnicities, all religions, allabilities and all lifestyles.“There

A REPORT OF HEALTH AND HUMAN SERVICES IN PALM BEACH COUNTY - BASED ON KEY COMMUNITY INDICATORS 2017 5 The "Report of Health and Human Services in Palm Beach County - Based on Key Community Indicators" continues to be a "living" document that is intended for use as a guide to making decisions, promoting