1. Community Profile 2007 Creek County Prepared by the Community Service Council of Greater Tulsa January, 2007

2. How Well do You Know Your Community? 1. How did Creek County’s population change between 2000 & 2005? a. down 8%b. no change c. up 2% 2. What percentage of Creek County’s 65+ population live alone? a. 10% b. 28%c. 41% 3. What percentage of Creek County’s elementary school children participate in the school free & reduced lunch program? a. 28%b. 45%c. 63% 4. What percentage of Oklahoma’s working age population have no health insurance? a. 13%b. 25%c. 48% 5. What percentage of Creek County’s population with disabilities are employed? a. 54%b.38% c. 22%

3. Community Profile 2007 Demographic Trends Human Development Panel Topics Best Practices

4. Demographic Trends in Creek County (part 1) Populations of Creek County, Sapulpa and Bristow have each increased 2% since 2000. Growing cultural diversity, particularly among the population <25 Living arrangements are changing significantly with more children living with a single parent, especially the mother, and living with other relatives, especially grandparents Demographic Trends

5. Creek County’s population 65+ projected to make up 21% of population by 2030 (up from 13% in 2000) Population <18 projected to account for 23% of population by 2030 (down from 27% in 2000) As working age population’s share declines, the 2030 projected dependency ratio climbs to 80 per 100, up from 67 per 100 in 2000 Demographic Trends in Creek County (part 2) Demographic Trends

6. Larger number of people over 65 years of age are living alone, especially women Median family income varies by race Large population of mobile renters Demographic Trends in Creek County (part 3) Demographic Trends

7. TAUW Service Area

8. Tulsa Metropolitan Statistical Area

9. Demographic Trends

30. Tulsa Area Human Development Industry What is it? Independent and collective action of efforts to address the education, health, housing, family support, emergency financial, and transportation needs of families and individuals in the Tulsa area. Increasingly these efforts seek to prevent needs through promoting increased self-sufficiency among people in the Tulsa area while still intervening to respond to crises and other concerns. Human Development

31. The Roots of the Challenge Thirty Year of Economic and Social Changes Emergence of new persistent poor in late 1960's and early 1970's Massive loss of low skill/high pay jobs Sharp rise in working poor Decline in young male workers' wages Increase in female headed families Impact of substance abuse All trends disproportionately affected: ~African-Americans ~young children & young families Human Development

32. Human Development: Key Points Middle class is disappearing Many households lack adequate income Stress of inadequate income and related conditions is widespread Starting life in Creek County for many is risky business Human Development

33. Human Development: Key Points… continued Populations of aging and persons with disabilities are large and growing Health challenges are critical to individual and community well-being Poor human conditions impact crime and growing incarcerations Overall progress in human development is tied to educational success Human Development

34. The Middle Class is Disappearing ~Lower income groups greatly expand, middle shrinks, highest income group increases dramatically Disappearing Middle Class

40. Many Households Lack Adequate Income ~More and more households lack adequate income to meet living needs

41. The Self-Sufficiency Standard Customized by specific family composition Customized by geographic location Based on all expense categories Updated annually using consumer price index …The level of income required for a family to meet its own needs Inadequate Income

57. Prepared by the Community Service Council of Greater Tulsa Inadequate Income

61. Stress of Inadequate Income and Related Conditions is Widespread ~Based on following key indicators : Poverty Families with children headed by women Youth 16-19 not in school or high school graduates Men 16-64 not employed or in labor force Inadequate Income

62. “Severely Distressed” and “Distressed” Neighborhoods Definitions Census tracts with at least 3 of the 4 following characteristics: 1. Percentage of people living in poverty Severely Distressed: 27.4% or more Distressed: 14.2 to 27.3% (1 standard deviation below) 2. Percentage of families with related children headed by women with no husband present Severely Distressed: 37.1% or more Distressed: 21.6 to 37.0% (1 standard deviation below) 3. Percentage of 16-19 year olds who are not enrolled in school and not high school graduates Severely Distressed: 23.0% or more Distressed: 11.5 to 22.9% (1 standard deviation below) 4. Percentage of civilian, non-institutionalized men ages 16-64 who are unemployed or not in the labor force Severely Distressed: 34.0% or more Distressed: 21.8 to 33.9% (1 standard deviation below) Taken from The Annie E. Casey Foundation and The Population Reference Bureau, 2003, “The Growing Number of Kids in Severely Distressed Neighborhoods: Evidence from the 2000 Census;” Inadequate Income

64. Additional Indicators of Economic Distress Public assistance programs Free & reduced school lunch program Homeless shelters Helpline and Babyline referrals Economic Distress Indicators

75. Starting Life in Tulsa for Many is Risky Business ~Combination of many risk factors takes heavy toll and early screening for risk level is inadequate

76. Starting Life

77. Adequate Early Screening Essential for All Children to Assess Impact of Risk Factors Some evidence indicates only small portion of children receive needed screening Sufficient data do not exist to clearly indicate extent and nature of problem

78. What is early intervention? Early intervention applies to children of school age or younger who are discovered to have or be at risk of developing a handicapping condition or other special need that may effect their development. Early intervention consists of the provision of services such children and their families need for the purpose of lessening the effects of the condition. Early intervention can be remedial or preventive in nature – premeditating existing developmental problems or preventing their occurrence. Early Screening

80. Populations of Aging and Persons with Disabilities are Large and Growing ~These populations will significantly test the capacity of resources needed to enable them to be most self-sufficient

81. Aging & Persons with Disabilities

82. Aging & Persons w/ Disabilities

83. Health Challenges are Critical to Individual and Community Well-being ~Inadequate income, high risks of starting life and poor lifestyle choices contribute to major health concerns

84. Health Challenges

86. Major Health Concern: Oklahoma and Tulsa County faring poorly compared to US in age-adjusted death rates, 1980 to 2002 Trend: Since 1993, US death rates declined but Tulsa Co and OK rates have not changed. Benchmark: Tulsa and OK death rates should not exceed the US rate. Individual responsibility is key to personal risk reduction. Good: The Tulsa Health Dept., St. Francis, OU and 18 Tulsa, Broken Arrow, Sand Springs and Union public schools have partnered to concentrate on risk reduction among school children. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, Center for Health Policy Research and Development, OUCPH, 2005; THD; United Health Foundation State Health Rankings, 2004 Health Challenges

88. OBESITY Trend: America’s weight gain epidemic – 25% of Americans are obese – more than doubled in 15 years. Benchmark: We must reverse this trend. Bad: Consequences – –high healthcare costs. –Increased heart disease, type II diabetes, osteoarthritis, hypertension, gallbladder disease, breast cancer, endometrial cancer and colon cancer. Bad: OK and Tulsa Co heart disease rates are higher than the rest of the nation – only one state ranks worse than OK. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, Center for Health Policy Research and Development, OUCPH, 2005; NCHS, CDC; THD; Tulsa County Health Profile; NIH; United Health Foundation; BRFSS, CDC; St. Francis Health System FY 2004 Community Needs Assessment. OK US THD – Patel/Woodruff 9/05 Major Health Concern: Poor Lifestyle Choices -- Obesity Health Challenges

90.  Trend: Percent of adult smokers (2003): 22.7(Tulsa Co), 25.1(OK), 22.0(US), state rank=36.  Benchmark: Smoking bans in public venues, smoking cessation programs, and increasing cigarette taxes = curtailed adult smoking and youth take-up rate.  Good: OK youth smoking percent is below the national average— 26.5(OK) and 27.5(US); adult smokers declining locally, statewide and nationally (2003).  Bad: Smoking is a major cause of premature death, cardiovascular and pulmonary system disease including heart attack, stroke and cancer. THD – Patel/Woodruff 9/05 NCHS, CDC; THD;Tulsa County Health Profile; NIH; BRFSS, CDC Major Health Concern: Poor Lifestyle Choices -- Smoking Health Challenges

92.  Tulsa’s uninsured and Medicaid beneficiaries seek primary care in Tulsa hospital ERs. ER visits by Medicaid recipients actually exceeded uninsured visits by 25%.  Tulsa hospital ER patient survey found that 73% were not true emergencies: 30% treated for non-emergency conditions – another 43% could have been treated in non-emergency facilities within 48 hours.  Using hospital ERs for non-emergency care is a costly and inefficient.  Non-emergency ER use is a major contributor to overload and frequent divert status of Tulsa hospital ERs — especially in the last 2 years. THD – Patel/Woodruff 9/05 Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, Center for Health Policy Research and Development, OUCPH, 2005; THD CAP Poor health conditions create huge inefficient demand on resources - Misuse of Hospitals and Emergency Rooms Health Challenges

93.  Of the 80 largest US metro areas, only Tulsa and Wichita lack ALL the components of a traditional public healthcare safety net infrastructure for indigent care. No public or university hospital. No comprehensive sponsorship of specialties/sub- specialties at medical schools. No hospital receiving Medicaid Disproportionate Share Hospital (DSH) funds for indigent care served. No hospital specifically organized and tasked to provide indigent care. No statewide support of Federally Qualified Health Centers (FQHCs); only one fully functional FQHC in Tulsa. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, OU Center for Health Policy, 2005 THD – Patel/Woodruff 9/05 Overall lack of health care resources for indigent care No Local Traditional Safety Net Health Challenges

94. Higher poverty correlates closely with higher percentages of uninsured and Medicaid recipients. Oklahoma ranks 40 th in the United Health Foundation’s state index rankings, but we are right on the average for states with similar levels of poverty. Poverty may be the greatest single determining factor in a state’s health rank accounting for almost 55% of the variance explanation. Generally, states with low poverty levels can expect to achieve higher health ranking without regard to other public health measures. THD, 2005; United Health Foundation State Health Rankings, 2004 OK The Influence of Poverty on Health Rankings Health Challenges

95. Poor Human Conditions Impact Crime and Growing Incarcerations ~Trends greatly affected by substance abuse

96. Oklahoma’s prison population was relatively stable until 1980 when laws passed to curb illegal drug use came into effect Oklahoma’s Prison Population 1950-2005 Source: Oklahoma State Department of Corrections, Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission in Tulsa. Note: Number of inmates in Oklahoma prisons, data as of June 30 of each year Crime & Incarceration

97. DOC Receptions Drug Crimes and Other Crimes FY1995 – FY 2005 Source: Oklahoma State Department of Corrections Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission in Tulsa. Crime & Incarceration

99. Overall Progress in Human Development is Tied to Educational Success ~From preschool through post secondary education

100. Educational Success: Attainment

103. Educational Success: Early Care & Learning

104. Growing importance of coordination among higher education institutions to promote system efficiency System Overview The State Regents prescribe academic standards of higher education, determine functions and courses of study at state colleges and universities, grant degrees, recommend to the state Legislature budget allocations for each college and university, and recommend proposed fees within limits set by the Legislature. A primary goal for the State Regents is “System Efficiency” especially focused on reduced program duplication. Tulsa Community College provides the lower level (Freshman & Sophomore) courses in Tulsa County and articulates agreements with all state supported four-year colleges and universities in Oklahoma for students wishing to pursue a bachelor’s degree. Tulsa Community College provides educational opportunities that can lead to Associate Degrees in Arts, Science, or Applied Science and to Certificates of Achievement. Educational Success: Higher Education

106. Human Development: Key Points Middle class is disappearing Many households lack adequate income Stress of inadequate income and related conditions is widespread Starting life in Creek County for many is risky business

107. Human Development: Key Points… continued Populations of aging and persons with disabilities are large and growing Health challenges are critical to individual and community well-being Poor human conditions impact crime and growing incarcerations Overall progress in human development is tied to educational success

108. Special Topics Infants and Young Children at Risk Adolescents at Risk Adults and Families at Risk

109. Infants and Young Children at Risk…

110. Top Risk Factors for Infants and Young Children Low-income and poverty Teen mother, especially those with more than one child Absent father Short spacing between births (less than 24 months) Parent, especially the mother, without a high school education Lack of positive emotional, physical and intellectual experiences Adverse childhood experiences

111. Poverty

112. Risk Factors for Infants

114. Early Care & Learning

116. The Adverse Childhood Experiences (ACE) Study Major American research project that poses the question of whether and how childhood experiences affect adult health decades later Provides compelling evidence that: –Adverse childhood experiences are surprisingly common –ACE’s happen even in “the best of families” –ACE’s have long-term, damaging consequences Findings reveal powerful relationships between emotional experiences as children and physical and mental health as adults ACE Study Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.”

117. The Adverse Childhood Experiences (ACE) Study Pyramid Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.” ACE Study

118. Adverse Childhood Experiences… Recurrent physical abuse Recurrent emotional abuse Sexual abuse An alcohol or drug abuser An incarcerated household member Growing up in a household with: Someone who is chronically depressed, suicidal, institutionalized or mentally ill Mother being treated violently One or no parents Emotional or physical neglect Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “What are Adverse Childhood Experieinces (ACE’s).” ACE Study

119. …Lead to Health-Risk Behaviors… Smoking Overeating Physical inactivity Heavy alcohol use Drug use Promiscuity Source: The Adverse Childhood Experiences Study website: www.acestudy.org ACE Study

120. …Which Cause Disease, Disability and Social Problems in Adulthood Heart disease Cancer Chronic lung and liver disease Stroke Diabetes Sexually transmitted diseases Nicotine addiction Alcoholism Drug addiction Obesity Depression Suicide Injuries Unintentional pregnancy Source: Felitti, Vincent J., “The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead;” CDC Media Relations, May 14, 1998, “Adult Health Problems Linked to Traumatic Childhood Experiences.” ACE Study

121. Risk Factors Increase Likelihood of Adverse Health and Social Outcomes ~ Adverse Outcomes for Infants and Young Children: Infant death Poor health Poor development Lack of school readiness Poor school performance Physical, mental or sexual abuse or neglect

122. Births to Teens

123. Impact of Adult Literacy & Education Levels on Children As the educational level of adults improves, so does their children's success in school; helping low-literate adults improve their basic skills has a direct and measurable impact on both the education and quality of life of their children. Children of adults who participate in literacy programs improve their grades and test scores, improve their reading skills and are less likely to drop out. Children's literacy levels are strongly linked to educational level of their parents, especially their mothers. Children of parents who are unemployed and have not completed high school are five times more likely to drop out than children of employed parents. Source: Oklahoma Literacy Resource Office. Adult Literacy & Education

124. Child Literacy

125. Child Abuse & Neglect in Oklahoma and Tulsa County Reports of child abuse and neglect have increased from 51,000 in 1997 to 61,610 in FY 2005 in Oklahoma (21% increase), and from 5,835 to 7,970 in Tulsa County (37% increase). Confirmed child neglect cases make up 2/3 of the confirmed cases. These types of cases increased 4% between 2000 and 2005. Overall, confirmed cases of abuse and neglect decreased by 21% between 2000 and 2005 in Tulsa County. In Oklahoma, 14.7 of every 1,000 children are victims of abuse and/or neglect. In Tulsa County, the rate is 7.9 of every 1,000 children (54% of the state rate). Oklahoma ranks #35 in the nation in the rate of children who are victims of abuse and/or neglect. Parents make up 74.3% of all perpetrators, followed by step-parents at 7%, “no relation” at 6.8%, and grandparents at 3.8%. Substance abuse is a major contributing factor to child neglect. Child Abuse & Neglect

132. Adolescents at Risk…

133. Top Risk Factors for Adolescents Poor academic performance Economic deprivation Alcohol, tobacco and other drug use Early sexual activity Unprotected sexual activity Family dysfunction Physical, mental or sexual abuse

134. YRBS

150. The Adverse Childhood Experiences (ACE) Study Major American research project that poses the question of whether and how childhood experiences affect adult health decades later Provides compelling evidence that: –Adverse childhood experiences are surprisingly common –ACE’s happen even in “the best of families” –ACE’s have long-term, damaging consequences Findings reveal powerful relationships between emotional experiences as children and physical and mental health as adults Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.” ACE Study

151. The Adverse Childhood Experiences (ACE) Study Pyramid Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.” ACE Study

152. Adverse Childhood Experiences… Recurrent physical abuse Recurrent emotional abuse Sexual abuse An alcohol or drug abuser An incarcerated household member Growing up in a household with: Someone who is chronically depressed, suicidal, institutionalized or mentally ill Mother being treated violently One or no parents Emotional or physical neglect Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “What are Adverse Childhood Experieinces (ACE’s).” ACE Study

153. …Lead to Health-Risk Behaviors… Smoking Overeating Physical inactivity Heavy alcohol use Drug use Promiscuity Source: The Adverse Childhood Experiences Study website: www.acestudy.org ACE Study

154. …Which Cause Disease, Disability and Social Problems in Adulthood Heart disease Cancer Chronic lung and liver disease Stroke Diabetes Sexually transmitted diseases Nicotine addiction Alcoholism Drug addiction Obesity Depression Suicide Injuries Unintentional pregnancy Source: Felitti, Vincent J., “The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead;” CDC Media Relations, May 14, 1998, “Adult Health Problems Linked to Traumatic Childhood Experiences.” ACE Study

155. Risk Factors Increase Likelihood of Adverse Health and Social Outcomes ~ Adverse Outcomes for Adolescents: Poor health Tobacco, alcohol or drug addiction School dropout Unemployment Sexually transmitted disease Teen pregnancy Abusive relationships (cycle of abuse) Juvenile delinquency/incarceration Suicide or other premature death

156. Disconnected Youth

157. Working Youths

158. Births to Teens

160. Juvenile Crime in Oklahoma Total juvenile arrests in Oklahoma fell 19.2% from 29,551 in 1995 to 23,880 in 2004 During that time period, arrests for violent crimes, non- violent crimes and alcohol related violations all declined, while arrests for drug abuse violations rose Juveniles accounted for 14.5% of all persons arrested in 2004 In 2004, 1,440 juvenile males and 2,219 juvenile females were arrested for runaway; 32% of those arrested for runaway were 13-14 years old Source: Oklahoma State Bureau of Investigation, 2004 Uniform Crime Report. Juvenile Crime

162. Youth Suicide in Oklahoma In 2000, 29 Oklahoma adolescents committed suicide -- 6 were under age 15. Suicide is the 3rd leading cause of death among 15-24 year olds. The majority of young Oklahomans who commit suicide use firearms. The rate of youth suicide is slightly higher in rural Oklahoma than in urban areas of the state. Source: Centers for Disease Control. Youth Suicide

163. Adults and Families at Risk…

164. Top Risk Factors for Adults and Families Single-parent households Low educational attainment Illiteracy Childhood abuse and other adverse childhood experiences Substance abuse/addiction Lack of health insurance/poor health care Poor diet & lack of exercise Tobacco use & excessive alcohol use

165. Educational Attainment

166. Adult Literacy

167. Substance Abuse

168. Health Insurance

169. Lapolla, Health Policy Analysis of the Tulsa Metropolitan Area, OU Center for Health Policy, 2005;. THD – Patel/Woodruff 9/05 Major Health Concern: Uninsured – Tulsa to Comparable Cities Health Insurance

170. Health Rankings

171. Risk Factors Increase Likelihood of Adverse Health and Social Outcomes ~ Adverse Outcomes for Adults and Families: Lower earnings/lack of economic self-sufficiency Domestic violence Crime/gang violence/incarceration Effects of adverse childhood experiences Disease or disability Suicide Premature death

172. Inadequate Income

173. Adult Literacy Levels and Income Over 20% of American adults read at or below a 5th grade level - far below the level needed to earn a living wage. 43% of people with the lowest literacy skills live in poverty. Workers who lack a high school diploma earned an average hourly wage of $9.50 in 2001, compared to $12.81 for high school graduates and $22.58 for those with a college degree. Source: Oklahoma Literacy Resource Office; Economic Policy Institute website. Inadequate Income

174. Domestic Violence

176. Oklahoma’s prison population was relatively stable until 1980 when laws passed to curb illegal drug use came into effect Oklahoma’s Prison Population 1950-2005 Source: Oklahoma State Department of Corrections, Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission in Tulsa. 1980 Note: Number of inmates in Oklahoma prisons, data as of June 30 of each year Crime & Incarceration

177. DOC Receptions Drug Crimes and Other Crimes FY1995 – FY 2005 Source: Oklahoma State Department of Corrections Prepared by the Community Service Council of Greater Tulsa for the Metropolitan Human Services Commission in Tulsa. Crime & Incarceration

178. The Adverse Childhood Experiences (ACE) Study Major American research project that poses the question of whether and how childhood experiences affect adult health decades later Provides compelling evidence that: –Adverse childhood experiences are surprisingly common –ACE’s happen even in “the best of families” –ACE’s have long-term, damaging consequences Findings reveal powerful relationships between emotional experiences as children and physical and mental health as adults ACE Study Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.”

179. The Adverse Childhood Experiences (ACE) Study Pyramid Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “About the Adverse Childhood Experiences Study.” ACE Study

180. Adverse Childhood Experiences… Recurrent physical abuse Recurrent emotional abuse Sexual abuse An alcohol or drug abuser An incarcerated household member Growing up in a household with: Someone who is chronically depressed, suicidal, institutionalized or mentally ill Mother being treated violently One or no parents Emotional or physical neglect Source: The Adverse Childhood Experiences Study website: www.acestudy.org, “What are Adverse Childhood Experieinces (ACE’s).” ACE Study

181. …Lead to Health-Risk Behaviors… Smoking Overeating Physical inactivity Heavy alcohol use Drug use Promiscuity Source: The Adverse Childhood Experiences Study website: www.acestudy.org ACE Study

182. …Which Cause Disease, Disability and Social Problems in Adulthood Heart disease Cancer Chronic lung and liver disease Stroke Diabetes Sexually transmitted diseases Nicotine addiction Alcoholism Drug addiction Obesity Depression Suicide Injuries Unintentional pregnancy Source: Felitti, Vincent J., “The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead;” CDC Media Relations, May 14, 1998, “Adult Health Problems Linked to Traumatic Childhood Experiences.” ACE Study

183. Health Rankings

184. Drug Addiction

185. Persons with Disabilities

192. Disease

194. Suicide

196. Mortality Rates

198.  Good:  Tulsa Co death rates parallel those of OK  Tulsa rates below the OK rate for most years;  2002 Tulsa rate lower than some metro areas of similar size and scope, including Oklahoma City.  Bad: By 2002 Tulsa County rate was 14.5% higher than the nation. THD – Patel/Woodruff 9/05 Major Health Concern: Tulsa’s high age-adjusted death rate compared to other areas Age-Adjusted Deaths Rates for Tulsa and Comparable Areas, 2002 Mortality Rates

199. Best Practices… A Research Based Approach Doing What Works

200. Best Practices Strategies Outcome performance measures Community coalitions –Collaborative, public-private partnerships –Consumer/client investments Successful outreach and recruitment Case management/Care coordination Strong social marketing Risk reduction education Access to services and care –Child care –Transportation –Translation Best Practices

204. How Well do You Know Your Community? 1. How did Creek County’s population change between 2000 & 2005? a. down 8%b. no change c. up 2% 2. What percentage of Creek County’s 65+ population live alone? a. 10% b. 28%c. 41% 3. What percentage of Creek County’s elementary school children participate in the school free & reduced lunch program? a. 28%b. 45%c. 63% 4. What percentage of Oklahoma’s working age population have no health insurance? a. 13%b. 25%c. 48% 5. What percentage of Creek County’s population with disabilities are employed? a. 54%b.38% c. 22%

205. Community Profile 2007 Creek County …is available on our website: www.csctulsa.org Prepared by the Community Service Council of Greater Tulsa January, 2007