1. WELCOME TO THE COMMUNITY HEALTH COALITION The Health Improvement Plan of Washtenaw County Carrie Rheingans, MPH, MSW Community Health Committee Co-Chair Project Manager Washtenaw Health Initiative Lily Guzmán, MPH, MSW Health Improvement Plan Coordinator Washtenaw County Public Health

2. HIP is a county-wide partnership working to improve the community’s health 1.Facilitate partnerships, 2.Collect & analyze local health data and sets health improvement objectives, 3.Promote evidence-based strategies. About the Health Improvement Plan

3. HIP Goals Partnerships GGrow partnerships across sectors and disciplines. Data CCollect, analyze, and disseminate data on health factors, outcomes, and disparities in Washtenaw County. EEstablish long term health objectives and monitor progress. Strategies IIncrease understanding of evidence-based strategies. IIncrease understanding of policy and environmental approaches. FFurther address social determinants of health, social justice, and health equity. DDevelop, implement, and monitor shared countywide health improvement plan.

4. Community Health Committee Coordinating Team Implementation Team Coalition Pa HIP Coalitions

5. Funding Partners 2015 HIP Survey Funding Partners

6. Ann Arbor Center for Independent Living Ann Arbor Public Schools - Community Recreation & Education Ann Arbor YMCA Area Agency on Aging 1-B Blueprint for Aging Chelsea-Area Wellness Foundation City of Ypsilanti Community Support and Treatment Services Hemophilia Foundation of Michigan HIV/AIDS Resource Center Hylant Group March of Dimes Michigan Institute for Clinical and Health Research National Kidney Foundation of Michigan Packard Health Regional Alliance for Healthy Schools (RAHS) School Based Health Centers St. Joseph Mercy Health System Slow Food Huron Valley Social Security Administration TheRide / Ann Arbor Transportation Authority United Way of Washtenaw County University of Michigan Comprehensive Cancer Center University of Michigan Health System University of Michigan Library - Health Sciences Libraries Washtenaw Area Transportation Study Washtenaw Asthma Coalition Washtenaw County Community Support and Treatment Services Washtenaw County Office of Community and Economic Development Washtenaw County Parks and Recreation Commission Washtenaw County Tobacco Reduction Coalition Washtenaw Health Plan Washtenaw Intermediate School District Ypsilanti Health Coalition HIP Partners

7. Ann Arbor Public Schools Ann Arbor Public Schools-Rec & Ed Ann Arbor Public Schools Pathways to Success Ann Arbor YMCA Catholic Social Services of Washtenaw County Center for Healthcare Research & Transformation Corner Health Center Growing Hope Hemophilia Foundation of Michigan IHN @ Alpha House Maternal Management LLC Mentor2Youth Inc. Ozone House Project Healthy Schools Slow Food Huron Valley Task Force on At Risk Youth The Young People's Project, University of Michigan University of Michigan Health System (UMHS) UMHS – Comprehensive Cancer Center UMHS – Project Healthy Schools UMHS – Regional Allice for Healthy Schools UMHS – Ypsilanti Health Center United Way of Washtenaw County Washtenaw Alliance for Children and Youth (WACY) Washtenaw Area Council for Children (WACC) Washtenaw County Community Support and Treatment Services Washtenaw Alliance for Virtual Education (WAVE) Washtenaw Community Health Organization Washtenaw County Office of the Sheriff Washtenaw County Office of Community & Economic Development Washtenaw County Public Health Washtenaw County Trial Court Washtenaw County Youth Center Washtenaw Health Plan Washtenaw Intermediate School District Today’s Attendees

8. Visit our website – http://hip.ewashtenaw.org http://hip.ewashtenaw.org Join our email list Attend meetings For more information

9. Lunch and refreshments Sign-in Restrooms Housekeeping

10. A big thank you to: Jessica Black, City of Ann Arbor Parks and Recreation Members of the At-Risk Task Force You! Meeting host: Naomi Norman Executive Director of Achievement Washtenaw Intermediate School District Today’s Topic: Every Child, Every Day

11. AT-RISK YOUTH: A DATA PORTRAIT Washtenaw County -- October 2014

12. Highest performing county in Michigan?  Number 1 in 8 th grade math (Kids Count)  Number 1 in 11 th grade reading (mischooldata.org)  Number 1 in 11 th grade math (mischooldata.org)  Half our high schools in the top 5% of all Michigan high schools (top to bottom ranking)  Several of the top high schools in the country (US News and World Report)

13. But are we the best for ALL kids?

14. Definitions of “At-risk” MDE Low achievement (levels 3 or 4) on Michigan Education Assessment Program (MEAP) tests in mathematics, reading or science Failure to meet core academic curricular objectives in English language arts or mathematics (applies to grade K-3 pupils only) OR Victim of child abuse/neglect Pregnant or parenting Eligible for free and reduced lunch Atypical behavior or attendance Family history of school failure, incarceration or substance abuse Washtenaw Alliance for Children & Youth (WACY) WACY has focused on “economically disadvantaged” school-aged youth in their recent shared outcomes process and defines that population by: *”… those who qualify for the free or reduced lunch program and/or youth from families with incomes below 185% of the federal poverty limit (FPL).” Task Force Input Mental health issues Physical health issues Substance abuse Age of first Criminal Justice Contact More than one traumatic experience Death of caregiver Witness violence Witness abuse, neglect Disposition Pattern of middle school failure English Language Learners African American males Middle school behaviors on/off track

15. How many students are free and reduced lunch eligible? How many students miss 10 or more days of school? 36 days or more? What percent of students score at the lowest level on the MEAP in all tested areas? Number of homeless youth 2012-13? What percent of students reported binge drinking in the last 30 days? Predictions

16. 14,128 Washtenaw County students eligible for free and reduced lunch in 2013-14 school year. Demographics 46,797 Students enrolled in Washtenaw Intermediate School District in 2013-14.

17. Demographics PercentRace/Ethnicity 64%White 18%African American 7%Asian 5%Hispanic 5%Two or more races 1%Others

18. Homeless Youth 1,316 Number of youth served by the Education Project for Homeless Youth in 2012-13.

20. Pair-Share What do you consider the most important criteria for being “At-risk”?

21. ACADEMIC PERFORMANCE

22. MEAP Math 4 th Grade by Race

23. ACT Math Comparison by Race

24. ACT Math Comparison by Income

25. Academic Performance 1,349 Number of students scoring lowest level of proficiency on ALL tested subjects. That is 17% of the students who were assessed by MEAP across all grades tested. 63% scored at least one “4”. Source: BAA

26. African American Math Performance 482 African American 8 th graders, Fall 2013 280 of those also in their district in 3 rd grade

27. Pair-Share What is one reason some groups of kids don’t perform as well as others?

28. ATTENDANCE

29. The Importance of Being in School

30. How are absence rates determined? Any absence from school or from a class period excused or unexcused examples: illness, skipping class, participating in school-sponsored activity, family vacation Calculated as a percent present of total time possible Example 1 Student misses 2-3 days per month = 18-27 days (80-85% attendance) Example 2 Student is late once a week and misses half a day = 18 days (85% attendance)

31. What is chronic absence? Michigan Department of Education Missing 10 days a year or more (5% or more) Attendanceworks.org defined as missing 10% of a school year for any reason Missing 18 days a year (or more) Severe chronic absence Missing 20% of the school year or more Missing 36 days or more

32. Source: MiSchoolData.org

33. 13,981 Students in Washtenaw County missed 10 or more days in 2012-13 Source: MiSchoolData.org

34. Source: MSDS 2013-14 Attendance Data Washtenaw County

35. Who is missing school? Which subgroups of students are impacted most? Average White student in Washtenaw County attends 171 days of school Average Black student attends 160 days of school Source: MSDS 2013-14 Attendance Data Washtenaw County

37. Suspension Patterns for Students with IEPs (Special Education) Type of Disciplinary Consequence Students with IEPs in Washtenaw County 2013-14 Approximately 6,100 students with disabilities with 1400 discipline consequences 1037 out-of- school suspensions 352 in school suspensions 11 expulsions Source: MSDS 2013-14 Discipline Data Washtenaw County

38. County Average

39. In Washtenaw County 2013-14: 1037 out of school suspensions for an average of 3.6 days each 3743 days of school missed Source: MSDS 2013-14 Discipline Data Washtenaw County

40. For More Information Attendance Works: http://www.attendanceworks.org/http://www.attendanceworks.org/ Chronic Absenteeism Report: http://new.every1graduates.org/wp- content/uploads/2012/05/FINALChronicAbsenteeismRepo rt_May16.pdf http://new.every1graduates.org/wp- content/uploads/2012/05/FINALChronicAbsenteeismRepo rt_May16.pdf Attendance data for all districts and schools in Michigan: http://mischooldata.org http://mischooldata.org For more information about this presentation and its data, please contact: Naomi Norman, Washtenaw ISD, nnorman@washtenawisd.org, 734-994-8100 ext. 1263 nnorman@washtenawisd.org

41. Pair-Share What is one reason that students miss school that you feel we can address?

42. DEPRESSION / SUICIDALITY

43. Adreanne Waller, MPH, Epidemiologist/Health Analyst Washtenaw County Public Health March 2013

44.  Interventions that Work  Adverse Childhood Experiences  Mortality  Behaviors/Risks  Emergency Department Admissions  Highlights  Connection between needs, interventions and data? Adreanne Waller, MPH - Washtenaw County Public Health

45. Mental Health Promotion For Whole Population Those Who Have Already Been Affected By Suicide or Suicidal Behaviors Persons With Risk Factors Like Depression

46. Adreanne Waller, MPH - Washtenaw County Public Health Mental Health Promotion For Whole Population Those Who Have Already Been Affected By Suicide or Suicidal Behaviors Persons With Risk Factors Like Depression What risk groups? Are we addressing? Opportunities for intervention? Other or different data needed?

47. SAMHSA Adreanne Waller, MPH - Washtenaw County Public Health

48. Create supportive environments that promote healthy and empowered Individuals, families, and communities Enhance clinical and community preventive services Promote the availability of timely treatment and support services Improve suicide prevention surveillance collection, research, and evaluation National Strategy for Suicide Prevention GOALS

49. “The truth about childhood is stored up in our bodies and lives in the depths of our souls. Our intellect can be deceived, our feelings can be numbed and manipulated, our perceptions shamed and confused, our bodies tricked with medication, but our soul never forgets. And because we are one, one whole soul in one body, someday our body will present its bill.” Alice Miller Adreanne Waller, MPH - Washtenaw County Public Health

52. Adverse Childhood Experiences Social, Emotional, & Cognitive Impairment Adoption of Health-risk Behaviors Disease, Disability Early Death The Influence of Adverse Childhood Experiences Throughout Life Death Birth Adreanne Waller, MPH - Washtenaw County Public Health

54. Vincent J. Felitti, M.D. Robert F. Anda, M.D.

55. Vincent J. Felitti, M.D. Robert F. Anda, M.D.

56. Childhood Experiences Underlie Chronic Depression Adreanne Waller, MPH - Washtenaw County Public Health Vincent J. Felitti, M.D. Robert F. Anda, M.D.

57. Childhood Experiences Underlie Suicide 1 2 0 3 4+ Adreanne Waller, MPH - Washtenaw County Public Health Vincent J. Felitti, M.D. Robert F. Anda, M.D.

58. *That portion of a condition attributable to specific risk factors Vincent J. Felitti, M.D. Robert F. Anda, M.D.

59.  Mental health is tightly linked to physical health Adreanne Waller, MPH - Washtenaw County Public Health

60. Suicide attempt monitoring, as well as other related measures, help us to take the ‘ten thousand mile view’ regarding what groups are at highest risk and where interventions may be most needed.

61. Adreanne Waller, MPH - Washtenaw County Public Health

62. Source: Michigan Department of Community Health and Washtenaw County Public Health Waller, A. suicidetrendsbyage.pptx 7/8/14suicidetrendsbyage.pptx

63. YOUTH Adreanne Waller, MPH - Washtenaw County Public Health

68. No Data 11.9% - 13.8% 13.9% - 15.3% 15.4% - 17.3% 17.4% - 20.6% Percentage of High School Students Who Were Electronically Bullied* *Including being bullied through e-mail, chat rooms, instant messaging, websites, or texting during the 12 months before the survey. State Youth Risk Behavior Surveys, 2013

69. Adreanne Waller, MPH - Washtenaw County Public Health

70.  Washtenaw County residents who were admitted to hospitals other than SJMH or UMHS for suicide attempts, i.e. VA  Suicide attempts that did not result in medical care  Completed suicides  Some ‘unintentional’ injuries Adreanne Waller, MPH - Washtenaw County Public Health

71. SAINT JOSEPH MERCY HOSPITALS & UNIVERSITY OF MICHIGAN HEALTH SYSTEM WASHTENAW COUNTY RESIDENTS ONLY Adreanne Waller, MPH - Washtenaw County Public Health

79.  Youth and young adults – increasing risks April/May and Sept/Oct  Latinos – higher risk  Asians – increasing risk  Access to lethal means – prescription drugs Adreanne Waller, MPH - Washtenaw County Public Health

81. SAFETY

82. What is MiPHY? Michigan online student health survey Grades 7, 9, 11 MiPHY or MiPHY Basic  MiPHY Basic excludes sexual behavior and suicide Available every other school year, even years 179 High School questions 161 Middle School questions Students complete in approximately 30 minutes

83. School Safety: Violence, Substance Abuse, Sexual Behavior MiPHY Survey results Grades 9 and 11 3,421 students 5 school districts Exit Survey results Grade 12 3278 students 14 school districts Senior Exit Survey

84. Bullying/Violence Amongst Youth MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

85. Percent of students who did not go to school because they felt unsafe at school or on their way to or from school on one or more of the past 30 days 3.4% MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

86. Bullying/Violence Amongst Youth Senior Exit Survey, Washtenaw & Livingston Counties, Class of 2014

87. Pair-Share How does bullying impact youth and their ability to learn?

88. SEXUAL BEHAVIOR

89. MiPHY: Sexual Behavior Grade9th11th % students “ever had sexual intercourse” 10.1%32.3% 14.5 % or 435 respondents reported having “sexual intercourse with one or more people during the past three months” MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

90. MiPHY: Relationship Violence MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

91. Pair-Share How does sexual behavior impact student learning?

92. SUBSTANCE ABUSE

93. Percent of Students… MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

94. Alcohol Use: Binge Drinking 8.5% of students binge drink: 279 students in MiPHY survey 9 th graders: 3.8% 11 th graders: 14.8% As/Bs: 7.9% Ds/Fs: 19.6% MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

95. MiPHY: Marijuana MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade

96. MiPHY: Other Drugs MiPHY 2013-14 Washtenaw County, n=3421, 9 th & 11 th grade MiPHY 2011-12 Washtenaw County, n=1115, 9 th & 11 th grade

97. Pair-Share What is one way we can address drug use?

98. OPPORTUNTIES

99. Why do some “at-risk” students succeed despite traditional indicators that predict otherwise? What correlates to success most closely? Resilience

100. Supportive Adults At least one adult at my school that I could count on to help and support me if I needed assistance Sometimes or Often: 78.3% Senior Exit Survey, Washtenaw & Livingston Counties, Class of 2014

101. Pilots  Engage Social Emotional Survey Pilot

102. Partnerships  School Justice Partnership  Washtenaw Futures

103. Table huddle What questions do you still have?

104. For more information:  School data: Naomi Norman, Washtenaw ISD, nnorman@washtenawisd.org nnorman@washtenawisd.org  School health data: Mary Beno, Washtenaw ISD & Livingston ESA, marybeno@livingstonesa.orgmarybeno@livingstonesa.org  Depression/Suicidality and ACE data: Adreanne Waller, Public Health, wallera@ewashtenaw.orgwallera@ewashtenaw.org  WACY Report Card: Ashley Kryscynski, aykryscynski@gmail.com aykryscynski@gmail.com