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San Diego Health Report Card Shows No Improvement In Child Immunization Rate

San Diego Health Report Card Shows No Improvement In Child Immunization Rate
San Diego Health Report Card Shows No Improvement In Child Immunization Rate
GUEST:Sandy McBrayer, Chief Executive Officer, The Children's Initiative

MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. Our top story on Midday Edition, the new report card is out on the health of children and families in San Diego. The report is issued every two years by the nonprofit organization, The Children's Initiative. It confirms what many similar surveys have found about the increase of kids and families living in poverty in San Diego. It also indicates that we are maintaining, not in a good way, our rates of childhood obesity. And there is an increase in the number of young children who are victims of violent crime. I would like to welcome Sandy McBrayer, Chief Executive Officer of The Children's Initiative. Welcome Sandy. SANDY MCBRAYER: Thank you very much, it's a pleasure to be here. MAUREEN CAVANAUGH: Now, let me start with one of the statistics that does jump out in the report. The increase in San Diego kids eleven and under who have been victims of violent crime. Tell us more about that. SANDY MCBRAYER: Well, we look at his when kids are out and unsupervised, what are they doing and where are they at? If so, what we've seen with our violent crime statistics is that, while all crime is decreasing, we don't want to just be looking across the board and say it is decreasing. We want to be a look at individual populations and say, are our children being exposed to crime? What we were able to do is look at not just the types of crimes, but the time of day and day of week. What we're seeing is the most critical time for young people, is after school between 2PM and 7 PM, where kids are unsupervised and don't have the care that they need, and they aren't at the age where they are developmentally making the best choices. So we're always trying to look, at how do we ensure that young people stay safe? How do we get them into afterschool programs? We will find solutions to keep them ñ when they are at the most risk ñ in the safest places. MAUREEN CAVANAUGH: What kind of violent crime are you talking about here? SANDY MCBRAYER: This is anything from being altercations with bullying, from fights to aggravated assault, across the board for young kids because they tend to respond with fists in many occasions and not with words. They don't have developmental skill of walking away from this, so we want to look at how do we empower young people to make better choices. MAUREEN CAVANAUGH: Now overall, what does the report tell us about San Diego children and crime? We've actually seen some improvement in the number of adolescents arrested for crimes. Haven't we? SANDY MCBRAYER: Certainly, and the county across the board. When I say county, I mean not only the County of San Diego, but community-based organizations and law enforcement. They began to look at all of the studies and say, how do we keep kids out of the justice system? We find when a child enters the justice system and into juvenile hall the first time, they are going to come back, on average. How do we stop that flow? We look at a lot of police departments working with the DA and public defenders, and look at our lowest level defenders and let's never let them get there. Let's refer them to our community-based organizations who can meet with the young person and family and figure out what is going on, and what that family and child need to actually get back into school or get reengaged in society. It has shown incredible success, and it has reduced our juvenile hall populations which has saved our county money. MAUREEN CAVANAUGH: And we have also got some good news in this report about DUIs. SANDY MCBRAYER: Yes, across the board when we look at the indicators and see that thirteen of our indicators have improved in this report card from prenatal care to breast-feeding. And some of them have actually been maintained, which I want to caution to say that is actually pretty good, concerning the economic status of our country, and what has happened in our committees. Many of these are maintaining is actually a positive, because many communities are actually going in the wrong direction. We still need to look at poverty of our youngest children and in communities where we see the highest hit in the central region and City Heights. When we look at substance abuse, overall looks like we are doing really well until we peel that onion and look at subpopulations. We see our seventh graders smoking marijuana at a higher rate than any other child. When we used to experiment at maybe 11th grade and then it dropped to 9th, you're seeing younger people experimenting with drugs. That is it real concern to make sure we have programs in place. And different age set. MAUREEN CAVANAUGH: You really burrowed into this data, how you compile the numbers for this report? SANDY MCBRAYER: The data sources vary. It could be from vital statistics, and it could be from Highway Patrol or local law enforcement. The San Diego Association of Governments public health records, what we have is a scientific review committee that works on this report, filled with epidemiologists, bio-statisticians, and I don't even know what they say half of the time. But it is making sure that our data is valid, and reliable, and consistent. We want to be able to look at data over time, and not just one time and say ìoh, we need to all jump on this.î It's like, is this affecting five kids or 5000? Not only that, but where? Is it a City Heights issue? Is it a Rancho Bernardo issue? If we have limited resources, we have to know where the population is that is moving in the wrong direction. MAUREEN CAVANAUGH: So you get the raw numbers and really crunch and drill down to find out not only what the age group is on substance abuse, you also find out where it is happening in the county. SANDY MCBRAYER: Yes, geographically we find over ninety-two percent of the indicators we can look by ZIP Code or census tract, and we can also look at ethnicity. We also look at breast-feeding or prenatal care. We say, who is most apt not to access prenatal care and let's actually work with communities and hospitals, to reach the right population. MAUREEN CAVANAUGH: How do we stack up against the last report card? That was issued in 2011. Are there any major changes that pop out for you? SANDY MCBRAYER: I think substance abuse, the marijuana smoking for seventh graders, that was not prevalent in that year. Our poverty, we expected it to increase and it has, that is there. Our crime is still decreasing, which is great. Our teen pregnancies are still decreasing, but that does not mean it's okay. We still need to get it to zero and that is what people also need to recognize. We want to eliminate these things, not just continue to decrease. It's not that our work is done, we still need to focus on it. Our children, we still have obesity issues in San Diego County and that surprises people because they think the number of parts and climate, kids are out there. If you ensure that kids are out there and it starts in adulthood. We as adults have to model that behavior for children. MAUREEN CAVANAUGH: I did mention the opening, and you mentioned the increase in poverty for San Diego. I suppose that you almost expected it, considering the hard economic times that we have been through. But tell us what the report did find out about poverty in our county. MAUREEN CAVANAUGH: SANDY MCBRAYER: There are some pockets where poverty grew significantly, and one of those was the central region, where we saw a large increase in immigrant refugee that was still struggling with one and two jobs at minimum wage, a lack of health coverage for those populations. And so, that is where we really look at limited services and make sure that we put them in the City Heights region to make sure that we're getting job training, earned income tax credit as they apply for income tax, we have to make sure that we get them the right place. We all have to say, are the services getting to the population? We have for the first time, the highest rates of eligible families receiving nutrition assistance with CalFresh, but we need to go further. We need to make sure that in the pockets of poverty, that they have the knowledge about the public services that are available and they are able to access them. MAUREEN CAVANAUGH: There's also an issue that you tackle in the report, the number of people in San Diego that do not have health care. I'm wondering, can we look at those numbers as a snapshot of the situation before the Affordable Care Act? And the expansion of Medicaid? SANDY MCBRAYER: We can go back in time and look at the two different correlations, what is important to us and what we talk about health coverage for adults, what we find with the national studies is that parents without health coverage don't go for checkups or well-being checks, or preventative care. What that translates to is their children do not go either. Which is crucially important for the developmental stages of children, to catch those things that are defensible early. So parents that don't have health care coverage are less likely to take children for checkups as well. MAUREEN CAVANAUGH: And along those lines, we have not seen an increase in the child immunization rate, is that a concern? SANDY MCBRAYER: That is a concern, for San Diego County and other places as well. What we know again, and here we go peeling the onion, we can say where in our County has the highest number of un-immunized children, San Diego County has the highest percent of personal belief exemptions in Southern California have any County. Our rate is higher than the state rate your MAUREEN CAVANAUGH: Tell us what that is. SANDY MCBRAYER: Of personal belief exemption is when a parent says they don't believe whether for religious or other reasons, that their child should be immunized. What we find work with that population, it is not poor families. It tends to be educated, middle-class, Caucasian white populations who might have read a study years ago that you might be familiar with out of England that said immunizations were linked to autism. Years later that study was proven to be false, and the author said that he falsified documents. Well they still have that in their mind that somehow immunizations are a danger. We are working in children's hospitals and doing a great project with the American Academy of Pediatrics to do physician led conversations with the parents to talk about safety. Because we know that is not just the child, that child comes in contact with elderly with compromised immune systems. Or a pregnant woman. That is the impact, the measles epidemic in 2000 in San Diego County tied to a voluntary unimmunized child, and people died. We have to make sure that is not just keeping that child safe, but the larger community that needs to be safe too. MAUREEN CAVANAUGH: You talk to just a moment ago about the rate of teenage pregnancies in San Diego and later in today's show we will really focus on that. The report card shows that the rates have gone down, and you have said that we want to get this to zero, unwanted pregnancies by teenagers. Is that downward trend continuing? Is that something that we have seen for number of years now and it continues to go down? SANDY MCBRAYER: It continues to go down and in San Diego County we are very fortunate, but what we see is is, for example when a young person has a baby, 20% of them will have a second baby within two years. If you're having a baby at fourteen, you'll have another baby at sixteen, you're still develop mentally not ready and your maturity level and your body is not ready. We have put programs into San Diego that are actually working with school-age children not just to get these pregnant girls back into schools but to teach them not to have a second baby, to hold off and wait. Their rate of second babies is 1.8% which is really successful and has attributed to our numbers dropping. We're still talking about 1000 young women having babies in our community too young. It's not okay, but we are doing great and we still have 1000 young mothers and 50% of those will never graduate from high school. Less than 10% will ever get into college. When you look at those and think what is their life trajectory, we have to do more work for those kids. MAUREEN CAVANAUGH: Sandy, the reason the county does these reports, as I understand it, is to see how well some of the county programs and outreaches are working, so based on the data that you have, what we you say is working in the county? When it comes to health, and social services that you measure. MAUREEN CAVANAUGH: SANDY MCBRAYER: When I mentioned juvenile crimes and when I worked with our probation and police departments, it's been successful to say it's not just punishment, but rehabilitation. It is to get on the right track. When I look at our work with school attendance and say, how do we get our kids going to school, we look at more women to initiate breast-feeding in the hospital and continue breast-feeding, the health of the baby and the mother with breast-feeding is so significant to the long-term health of mother and child. It's long-term work that we're doing well, but part of this report card is also used for policy direction, so we can say what needs to change. How do we look at our policies if we're seeing an increase with young people with e-cigarettes? What are our county and city policies to make sure that young people don't have access to those? Part of what we look at with the county and this is policy, how do we make sure that our eligible families can access food stamps and ask them in their communities. Outstation community workers, or give the authority for community-based based organizations to help enroll families, that is a policy shift. MAUREEN CAVANAUGH: Do you actually go around with the results of this report to different communities and basically say, look at what is happening in your community or your community is experiencing this problem, so this is where resources should be targeted? SANDY MCBRAYER: It's interesting because people think you have released a report card so you can actually rest, no, the work has just started. Before the end of the year, will probably do fifty community presentations and it could be to school boards, community clinics, the hospital association, to community collaboratives. We don't actually take County data, we take their data, when we are at Tri-City Hospital board, we actually give them the North County data and we say to them: here are your four top issues. Or here are the top issues in your ZIP Code. What is unique about this report card it's not just data. We actually identify the national best practice or evidence-based practices that will improve the indicator. When we say, this will change that, then we make San Diego recommendation so we go in front of that community group we say here are your three top issues, and there are three things you can do to change the indicator so it will improve. MAUREEN CAVANAUGH: To get enough resources and support from the county to do that? SANDY MCBRAYER: We do get resources from the county, but this is a public-private partnership. When we did the study on the best report cards in the nation, we've actually found that if it was solely county funded when the county budget dropped, the report card went away. From the California endowment to the Dickinson Family Foundation to the McCarthy Family Foundation, we bring in foundation dollars to support those efforts to be able to go into the community and say, you have power to change this both as an individual as a resident, you can make a difference in improving the lives of yourself and your family. And let's teach you how to do that. MAUREEN CAVANAUGH: I know a lot of people listening are probably very interested in finding out the details of what is in the report. You can see the entire San Diego County report card on children and families on our website at I've been speaking with Sandy McBrayer, chief executive officer of The Children's Initiative, Sandy thank you so much. SANDY MCBRAYER: It was my pleasure, thank you very much.

San Diego County Report Card on Children and Families
Every two years The Children's Initiative offers a detailed analysis of 25 key indicators of the health and well being of children throughout San Diego County. But the Report Card goes beyond metrics it also reveals why the findings are important and recommends practices to improve each problem.
To view PDF files, download Acrobat Reader.

A new report card is out on the health of children and families in San Diego. The report is issued every two years by the non-profit organization The Children's Initiative.

It confirms what many similar surveys have found about the increase of kids and families living in poverty in San Diego. But it also indicates that we are maintaining, not in a good way, our rates of childhood obesity, and there's an increase in the number of young children who are victims of violent crime.


Among the improvements, the report shows a decrease in the number of adolescents arrested for crimes.

The Children's Initiative CEO Sandy McBrayer said this is due in part to the recognition that a lot of juvenile crimes can be handled at the community level.

"Once you enter the [juvenile] hall, your chances of returning are four times greater," McBrayer said.

She said a focus on increasing juvenile diversion means adolescents who commit low-level crimes, including shoplifting and breaking curfew, are being referred to community-based organizations that provide services to prevent youths from re-offending and to get them back to school.

The report also found that the child immunization rate is the same as it was more than a decade ago, with only 81 percent of young children receiving basic immunizations.


San Diego's rate of parents citing personal belief exemptions for vaccination is higher than the state average, McBrayer said.

When children who are not immunized contract an illness such as measles or whooping cough, they are often fine, she said. But what those children's parents may not see is the elderly person or pregnant woman who became seriously ill or died as a result of the illness, McBrayer said.