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Maryland’s Results for Child Well- Being 2005 Maryland’s Results for Child Well- Being State of Maryland Children’s Cabinet 2005 Robert L. Ehrlich, Jr. Governor Michael S. Steele Lieutenant Governor Arlene F. Lee Executive Director Maryland’s Results for Child Well- Being 2005 2 Maryland’s Results for Child Well- Being 2005 3 MARYLAND’S RESULTS FOR CHILD WELL- BEING 2005 Robert L. Ehrlich, Jr., Governor Michael S. Steele, Lt. Governor Maryland Children’s Cabinet Governor’s Office for Children 301 W. Preston Street, 15th Floor Baltimore, Maryland 21201 Tel: 410- 767- 4160 Fax: 410- 333- 5248 www. goc. state. md. us Maryland’s Results for Child Well- Being 2005 4 Dear Citizens of Maryland, I am grateful to the members of the Children’s Cabinet for their diligent work and effort to improve the lives of Maryland’s children and families. Government has a dual responsibility to its citizens. While we work to protect our most vulnerable citizens, we also need to enhance and advance the lives of our youth in a positive, pro- active manner to ensure they become fully engaged as physically and emotionally healthy adults and contributing members of our economy as well as our society. It is clear that the enthusiasm and teamwork of the Children’s Cabinet is changing the way families are viewed and served by our state and local agencies. The dedication of each Cabinet member, and the hard work of every person in their individual departments, is evident as we see positive changes in the lives of many families. Some of these changes are reflected in the Results for Child Well- Being, some are just starting to make an impact. Our progress will continue as we implement the necessary safeguards for our families and advance important early childhood initiatives. We still have challenges to overcome, but together we will do the necessary work to make certain that Maryland’s children have the tools they need to be fully prepared to carry out the work of the future. Sincerely, Robert L. Ehrlich, Jr. FROM THE GOVERNOR Maryland’s Results for Child Well- Being 2005 5 FROM THE EXECUTIVE DIRECTOR Dear Governor Ehrlich and Citizens of Maryland: I am proud to submit the 2005 Maryland’s Results for Child Well- Being. I believe this publication is one of the Governor’s Office for Children’s most important contributions to the State’s efforts to address the needs of children and families. The eight results for child well- being were established to identify the most effective way to assess a child’s social, emotional, and physical health. These result areas include: Babies Born Healthy, Healthy Children, Children Enter School Ready to Learn, Children Suc-cessful in School, Children Completing School, Children Safe in their Families and Com-munities, Stable and Economically Independent Families, and Communities that Support Family Life. These areas allow the State to effectively evaluate the challenges that Mary-land’s children face; select priority areas; set goals for improving child and family well-being; and monitor the impact of resources, such as services, programs and initiatives, have on the children and families served. The benefit of having one comprehensive source for data is that everyone, from local agencies to State officials, utilizes the same integrated, statistically sound information when making critical decisions about children and children’s issues. The Children’s Cabi-net, which includes all of the State’s child- serving agencies, uses this information to help identify populations of children who are in need of assistance, services that are falling short, and best practices and policies to raise a child’s chances for success. Additionally, Local Management Boards, which are comprised of the local social services, juvenile ser-vices, health and mental hygiene, local public schools, and private agencies, use the data to develop their community needs assessment and to establish their multi- year funding agree-ments with the Children’s Cabinet. Governor Ehrlich’s Children’s Cabinet remains committed to working together under one mission: to better the lives of children and families. We have made great progress in our efforts to assist Marylanders, and I am proud of our good work. This publication is our report to the community; one that is meant to promote, support, and identify the needs of our children. While we have many successes to highlight, we must continue to support an interagency approach to serving children and families in order to ensure that all children are safe, healthy, and well prepared for adulthood. For more information, please visit the Governor’s Office for Children website at www. goc. state. md. us; click on Results and Indicators. Sincerely, Arlene F. Lee Maryland’s Results for Child Well- Being 2005 6 Letter from the Governor ......................................................................................... 4 Letter from the Executive Director .......................................................................... 5 Guide to Results and Indicators ............................................................................... 7 Babies Born Healthy................................................................................................ 13 Infant Mortality .............................................................................................. 14 Low Birth Weight........................................................................................... 16 Births to Adolescents...................................................................................... 18 Healthy Children...................................................................................................... 21 Immunizations ................................................................................................ 22 Injuries............................................................................................................ 24 Deaths............................................................................................................. 26 Substance Abuse............................................................................................. 28 Children Enter School Ready to Learn.................................................................. 31 Kindergarten Assessment ............................................................................... 32 Children Successful in School ................................................................................. 35 Absence From School..................................................................................... 36 Academic Performance .................................................................................. 38 Demonstrated Basic Skills.............................................................................. 40 Children Completing School................................................................................... 43 Dropout Rate .................................................................................................. 44 High School Completion Program ................................................................. 46 High School Diploma ..................................................................................... 48 Graduation/ School Completion of Children with ED..................................... 50 Children Safe in Their Families and Communities............................................... 53 Abuse or Neglect ............................................................................................ 54 Deaths Due to Injury ...................................................................................... 56 Juvenile Violent Offense Arrests.................................................................... 58 Juvenile Serious Non- Violent Offense Arrests............................................... 60 Domestic Violence ......................................................................................... 62 Stable & Economically Independent Families....................................................... 65 Child Poverty.................................................................................................. 66 Single Parent Households............................................................................... 68 Out- of- Home Placements ............................................................................... 70 Permanent Placements.................................................................................... 72 Homeless Adults and Children....................................................................... 74 Communities That Support Family Life................................................................ 76 Appendices................................................................................................................ 78 History of Results and Indicators ................................................................... 79 Glossary & Source List .................................................................................. 80 The data in this report are gathered at the State and local levels but have a statewide focus for the purposes of this publication. Information about a specific local level indicator may be accessed at www. goc. state. md. us. TABLE OF CONTENTS PUBLICATION STAFF: David Ayer Deborah Harburger Tara D. Murphy Susan Russell Walters Published: August 2005 Maryland’s Results for Child Well- Being 2005 7 GUIDE TO RESULTS AND INDICATORS FROM THE GOVERNOR WHAT ARE RESULTS AND INDICATORS? What is a result? A goal that Maryland has established for its children, families and/ or com-munities. Maryland has eight results. Each describes the general well- being of Maryland’s children and families in an area we know affects a child’s ability to grow up healthy and secure. Babies Born Healthy Children Completing School Healthy Children Children Safe in Their Families & Communities Children Enter School Ready To Learn Stable & Economically Independent Families Children Successful In School Communities That Support Family Life What is an indicator? Information that demonstrates Maryland’s progress toward meeting a result. USING MARYLAND’S RESULTS AND INDICATORS The Children’s Cabinet, in cooperation with local jurisdictions, strives to meet the needs of Maryland’s children, families and communities. Through this collaborative approach, each jurisdiction identifies and focuses on results and indicators that are priorities in their community. The information in this publication assists in tracking and evaluating the well- being of children across the State and in each local area. Indicators are used to: ♦ Assess and understand the current status of children and families and how trends emerge over time: • Examine data for population subgroups, such as race, sex, and age, to find major differences across the groups to ensure that all children and families do well. • Analyze trends to identify where results have been changing on a local level in ways that are different from state- wide trends. This assists local jurisdictions in targeting potential priority areas. • Provide parents and communities with the information and resources they need to understand the status and trends concerning children in their communities. ♦ Select priority areas and set goals for the improvement of child and family well- being: • Use the indicators to identify troubling trends, to choose strategies to address the Maryland’s Results for Child Well- Being 2005 8 problem area, and to measure progress towards set goals. • Compare and collaborate with similar jurisdictions to help identify potential strategies. • Choose intervention strategies that will achieve progress toward the goals. Use indicators as part of strategic planning. • Help parents and communities to be better informed and become more involved in setting goals for improvement in their communities. ♦ Monitor progress toward goals in comparison with invested resources made in selected programs, services, and initiatives. Indicator data will help assess intervention strate- GOVERNOR Four years ago the result area “ Children Enter School Ready to Learn” became and continues to be a central focus of attention for the Children’s Cabinet and for the Maryland Legisla-ture’s Joint Committee for Children, Youth and Families. A key indicator of school readiness ( Kindergarten Assessment) has become available through the Maryland Model for School Readiness, and has been added to this result area. This has increased the State’s ability to better assess the degree to which we are achieving this important result. More recently, the Children’s Cabinet created a time- limited workgroup, to examine possible indicators for the result area “ Communities Which Support Family Life.” This workgroup affirmed the conclusion reached in the first effort to develop statewide measures for this re-sult area: each community has unique strengths, concerns and priorities and, therefore, indi-cators for this result area should remain locally determined. This workgroup also considered possible indicators that could measure positive youth devel-opment. The interest in and the wide range of positive ways that school- age children and youth grow and develop have spurred the State to include youth development concepts in assessing how older children are faring. The youth development movement marks an inno-vation in the field of child and youth policy equivalent to the important contribution made by the school readiness movement in the field of early childhood care and development. New to Maryland’s Results for Child Well- Being last year was the inclusion of youth devel-opment in the discussion of a number of the current results and indicators, as applicable. Youth development focuses on supporting positive developmental processes that occur from about age 6 to the early 20’ s, as opposed to focusing on risk and problem behaviors. The Children’s Cabinet agreed this emphasis should start with children at age 5, to create a seam-less transition from early childcare and education. For simplicity, the age ranges were di-vided roughly by school stages: ages 6– 10 ( elementary school); ages 11– 14 ( middle school); and ages 15– 19 ( high school). The Children’s Cabinet recognized that many older youth are not fully prepared for adulthood by age 18, and in the future may consider indicators up to age 24. The goal of the youth development approach is to create an environment for youth to grow and mature to their fullest potential, targeting positive outcomes, using human and structural supports, and occurring in a variety of settings. Outcomes, supports and settings will differ over these two decades depending on the age of the youth and the developmental milestones they are working to achieve. Additionally, outcomes, supports and settings should include not only school time and academics, but also other activities that fully prepare youth for be-ing an adult in the vocational, physical, emotional, social and civic realms. To ensure that no major areas of a young person’s life were left out, the wide range of ways children and youth develop were organized into five overarching areas: FOCUS ON YOUTH DEVELOPMENT Maryland’s Results for Child Well- Being 2005 9 DESCRIPTIVE GUIDE TO THE RESULTS AND INDICATORS Indicator Definition Significance Baseline Data Data Sources Considerations Related Measures Discussion The information on each indicator is organized as follows: A brief description of the indicator. A detailed description of the indicator. A brief discussion of why this indicator is important and how it relates to child and family well- being. Where available, multi- year state and national data are shown. The name of the agency that produces the data and a brief description of the break-downs that are available ( e. g. broken down by age, race, or gender). Special information about the source, the definition or the significance of the indica-tor that may be helpful when using the indicator to track trends or to set perform-ance goals. If they exist, other measures that relate to the indicator will be listed along with the source of data. A brief overview of the trend that exists for this indicator, factors that may be im-pacting the trend, and what is happening at the State level to address this indicator are discussed in this section. This section may include additional information on how the indicator relates to youth development. Self- Sufficiency — Promoting the basic skills and information needed to obtain and retain a job; promoting employment; and fostering participation in careers that al-low one to give back to their community. Learning — Promoting the basic and higher order skills needed to succeed in a job and/ or four- year university; preventing school failure and dropout; facilitating school success and completion; and fostering participation in efforts to improve schools and community- based organizations. Physical Health — Promoting health and fitness habits; preventing injury, illness and death; and fostering participation in community health promotion events. Mental Health and Social Competencies — Promoting the social and emotional skills, values and support systems needed to maintain a balanced personal life and family; preventing suicide, teen pregnancy, and alcohol and drug abuse; and foster-ing participation in peer groups and communities as a positive, supportive friend and neighbor. Cultural and Civic Contributions — Promoting the basic skills and information needed to participate in cultural and civic life; preventing crime and violence; and fostering participation in the community as voters, volunteers, artists, advocates, decision- makers and leaders. Maryland’s Results for Child Well- Being 2005 10 THE GOVERNOR A GUIDE TO STATISTICS The following is a brief description of two key statistics used throughout this guide ( percent and rate), a word of caution about their use in setting goals, and instructions on how to calculate the rate- of- change statistic in order to track trends. Percent: Percent means per 100. For example, 15% means 15 out of 100, 75% means 75 out of 100. Percent = ( Number in sub- group) ÷ ( Number in whole group) x 100 Example: Percent of babies born at low birth weight ( LBW), 2002 Percent = ( Number LBW) ÷ ( Total number of births) x 100 = 6,623 ÷ 73,250 x 100 = 9% of births in 2002 were less than 2,500 grams ( 5.5 pounds) Rate: The easiest way to understand a rate is to think of a percent as a rate per 100. In the example above, 9% of babies born at low birth weight could also be expressed as “ 9 babies per 100” are born at low birth weight. Rate = ( Number in sub- group) ÷ ( Number in whole group) x MULTIPLIER Example: Rate of youth ( 10- 17) arrested for violent crimes per 100,000, 1998 Rate = ( Number arrested) ÷ ( Number of youth ages 10- 17) x 100,000 = 3,037 ÷ 567,678 x 100,000 = 535 per 100,000 youth ages 10- 17 were arrested for violent crimes in 1998 Rate of Change: It is helpful to see how an indicator has changed over time. The rate of change refers to the magnitude of the change from one time frame to another ( e. g. from 1995 to 1998). Rate of change is expressed as a percentage. A positive percentage indicates an upward trend while a negative percentage denotes a downward trend. Rate of Change = {[( Recent year number) ÷ ( Prior year number)] - 1} x 100 Example: Rate of change in the rate of out- of- home placement, FY98 to FY99 Rate of Change = {[( FY99 rate of placement) ÷ ( FY98 rate of placement)] - 1} x 100 = {[ 11.2 ÷ 12.1 ] - 1} x 100 = - 7.4% is the rate of change in the rate of placement from FY98 to FY99. Be Careful When Using Percentages or Rates to Set Goals: Caution is necessary when using percentages and rates to set performance goals. If the item to be measured has less than 5 occurrences ( e. g. Infant mortality in a given zip code area for a given year) then a percentage or rate should not be produced. One or both of the following methods can be employed to create a more stable percentage or rate: • Multi- year averaging, which involves using a longer time period to produce the rate ( e. g., Use 3 or 5 years data); or • Enlarging the geographic area, ( e. g., use a region containing several zip codes). Both of these methods increase the number of observed events and hence the stability of per-centages or rates being produced to set goals. Maryland’s Results for Child Well- Being 2005 11 THE GOVERNOR METHODOLOGY FOR STATE MAPS Included in the report are statewide composite maps for each Result area. These maps offer a visual representation of each county’s efforts. For each result area, with the exception of Com-munities Which Support Family Life, a map illustrates each jurisdiction’s standing in Mary-land. A jurisdiction’s standing is determined by the sum of the jurisdiction’s ranking on each of the indicators in that Result area ( e. g., for Babies Born Healthy, the sum of a jurisdiction’s rankings on Infant Mortality, Low Birth Weight, and Births to Adolescents). The maps illus-trate five levels of State standing in sequential order from highest/ best ( 1) to lowest/ worst ( 24). Indicators without jurisdictional data are excluded from the Maryland maps. The indicators containing jurisdictional data used for each Maryland Map are listed below: Babies Born Healthy Healthy Children Infant Mortality Injuries Low Birth Weight Deaths Births to Adolescents Substance Abuse Children Enter School Children Completing School Ready to Learn Dropout Rate Kindergarten Assessment High School Program Completion High School Diploma Children Successful in School Absence from School Stable and Economically Self- Sufficient Academic Performance Families Demonstrated Basic Skills Child Poverty Single Parent Households Children Safe in their Families Out- of- Home Placements and Communities Permanent Placements Abuse or Neglect Homeless Adults and Children Deaths Due to Injury Juvenile Violent Offense Arrests Juvenile Non- Violent Offense Arrests Two improvements in the Maryland Maps are made in this year’s report: • Children Successful in School: The Academic Performance indicator has shifted from the Maryland School Performance Assessment Program ( MSPAP) to the new Maryland School Assessment ( MSA). • Children Safe in their Families and Communities: Starting in 2004, the map ex-cluded the indicator Domestic Violence. Domestic Violence is a critical indicator of family well- being. The measure for this indicator, the rate of victims receiving domestic services from programs funded by the Maryland Department of Human Resources, provides incomplete information regarding the actual incidence of do-mestic violence in Maryland. In the interest of providing a more accurate picture of Children Safe in Their Families and Communities, this indicator has been removed. Maryland’s Results for Child Well- Being 2005 12 Maryland’s Results for Child Well- Being 2005 13 BABIES BORN HEALTHY THE GOVERNOR BABIES BORN HEALTHY INDICATORS: INFANT MORTALITY: The rate of deaths occurring to infants under 1 year of age per 1,000 live births. LOW BIRTH WEIGHT: The percent of babies born at low birth weight, weighing less than 2,500 grams ( about 5.5 pounds) and very low birth weight, weighing less than 1,500 grams ( about 3.3 pounds). BIRTHS TO ADOLESCENTS: The rate of births to ado-lescents less than 20 years of age. Maryland’s Results for Child Well- Being 2005 14 INFANT MORTALITY Indicator Definition Significance Baseline Data Data Sources Considerations Related Measures Discussion The rate of deaths occurring to infants under 1 year of age. The rate ( per 1,000 live births) of all births and births in various racial/ ethnic groups who do not survive beyond year one. Indicator is associated with family access to health care and prenatal, family, and environmental risks to a child’s healthy start. INFANT MORTALITY ( reported by calendar year) Maryland - Vital Statistics Administration, Department of Health and Mental Hy-giene ( DHMH). Data are reported by jurisdiction. National - National Center for Health Statistics, Centers for Disease Control. ( National 2003 data - preliminary) National comparisons as well as national and State trend data are available. If mor-tality rates are tracked in small jurisdictions, multi- year averaging may be neces-sary. A “ service delivery/ utilization” indicator that is often used as a proxy for results in this area is percent of births for which prenatal care was initiated in the first trimes-ter ( for all births, for various racial/ ethnic groups, for various age groups). Data are reported by Vital Statistics, DHMH, by race and by jurisdiction. The infant mortality rate in Maryland increased in 2003 to 8.1 per 1,000 live births from 7.6 in 2002, the highest it has been since 1999. The increase was due to the increase in infant mortality of African Americans. The African American mortality rate increased and the White rate remained the same resulting in an increased gap between the infant mortality rates for the two groups. In 2003, African American infants in Maryland were 2.7 times more likely to die than White infants, up from 2.4 in 2002. Infant deaths per 1,000 live births Maryland 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 All Races 8.8 8.7 8.4 8.6 8.6 8.3 7.4 8.0 7.6 8.1 White 6.0 6.0 5.9 5.3 5.5 5.1 4.7 5.5 5.4 5.4 African Am 15.2 15.3 14.5 16.1 15.4 14.7 13.0 13.6 12.7 14.7 National 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 All Races 8.0 7.6 7.3 7.2 7.2 7.1 6.9 6.8 7.0 6.9 White 6.6 6.3 6.1 6.0 6.0 5.8 5.7 5.7 5.8 5.8 African Am 15.8 15.1 14.7 14.2 14.3 14.6 14.1 14.0 14.4 14.1 Maryland’s Results for Child Well- Being 2005 15 The leading causes of infant death in 2003, as in 2002, were: ( 1) disorders relating to short gestation and unspecified low birth weight; ( 2) congenital malformations, deformations and chromosomal abnormalities; and ( 3) Sudden Infant Death Syn-drome ( SIDS). Rates for all three causes were higher for African Americans than Whites. However, the leading causes of death for White infants were congenital malformations, deformations and chromosomal abnormalities, while the leading cause of deaths for African American infants were disorders relating to short gesta-tion and unspecified low birth weight. The overall infant mortality rate in Maryland continues to be higher than the na-tional rate. However, White infant mortality rates are lower in Maryland than in the United States, while rates for African Americans are higher. Infant Mortality Rates Maryland and National 1994 to 2003* 2 4 6 8 10 12 14 16 18 20 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Rate per 1,000 Maryland National * 2003 National data are preliminary. Infant Mortality Rates Maryland and National by Race 1994 to 2003* 2 4 6 8 10 12 14 16 18 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Rate per 1,000 NAT'L White MD White NAT'L African American MD African American * 2003 National data preliminary. Maryland’s Results for Child Well- Being 2005 16 LOW BIRTH WEIGHT Indicator Definition Significance Baseline Data Data Sources Considerations Related Measures The percentage of babies born at low birth weight, weighing less than 2,500 grams ( about 5.5 pounds) and very low birth weight, weighing less than 1,500 grams ( about 3.3 pounds). The percent of all births, births in various racial and ethnic groups, and births to mothers in various age groups with birth weights less than 2,500 grams ( low birth weight) and less than 1,500 grams ( very low birth weight). Infant birth weight is associated with infant survival, health, and overall develop-ment. Infants weighing less than 2,500 grams are more likely to have physical and developmental problems, including mental retardation, developmental delays, visual and hearing deficits, chronic respiratory problems, and learning difficulties. LOW BIRTH WEIGHT ( reported by calendar year) Maryland - Vital Statistics Administration, Department of Health and Mental Hy-giene. Data are available, but not published, on the number of low and very low birth weight babies by both maternal age and race. Data are also available by low and very low birth weight and by race for jurisdictions. National - National Center for Health Statistics, Centers for Disease Control ( National 2003 data - preliminary). This indicator supports both a national and State health goal. Healthy People 2010 has set a national goal of 95 percent of infants to be born weighing 5.5 pounds or greater by the year 2010. At the state level, Healthy Maryland 2010 has set a goal to reduce the incidence of low birth weight to no more than 8% by the year 2010. Na-tional comparisons as well as national and State trend data are available. A “ service delivery/ utilization” indicator that is often used as a proxy for results in this area is percent of births for which prenatal care was initiated in the first trimes-ter ( for all births, for various racial/ ethnic groups, for various age groups). Data are reported by Vital Statistics, DHMH, by race and by jurisdiction. Percent of Births less than 2,500 grams Maryland 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 All Races 8.4 8.5 8.6 8.8 8.7 9.1 8.7 9.0 9.0 9.1 White 6.2 6.2 6.3 6.3 6.4 6.7 6.4 7.0 7.0 7.1 African Am 13.1 13.5 13.4 13.7 13.1 13.7 12.9 13.0 13.3 13.1 National 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 All Races 7.3 7.3 7.4 7.5 7.6 7.6 7.6 7.7 7.8 7.9 White 6.1 6.2 6.3 6.5 6.5 6.6 6.5 6.7 6.8 7.0 African Am 13.2 13.1 13.0 13.0 13.0 13.1 13.0 13.0 13.0 13.5 Discussion Low birth weight ( LBW) is the primary cause of infant mortality. Also, LBW in-fants have a higher probability of experiencing developmental delays. LBW babies Maryland’s Results for Child Well- Being 2005 17 may be born either prematurely ( before 37 weeks gestation) or full term ( 40 weeks gestation) but small for gestational age. Infants of multiple births ( twins, triplets or higher order) have a significantly higher risk of being born LBW than singletons. The percent of LBW infants born in Maryland continues to be higher than the na-tional average. The percent of LBW infants increased 1.1% from 2002 to 2003. However, the LBW rate for White infants increased slightly while the African- American rate decreased slightly. In general, trends show that the percentage of LBW births is slowly increasing in Maryland and nationally. One factor that may cause this increase is the number of twins and higher order births. In a study using data from 1995 to 1997, Maryland was among 10 states with the highest rate of twin and higher order births. In 2003, 58.9% of plural births were LBW compared to 7.1% of singleton births. Percent of Low Birth Weight Babies Maryland and National 1994 to 2003* 2 4 6 8 10 12 14 16 18 20 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Percent Maryland National * 2003 National data are preliminary. Percent of Low Birth Weight Babies Maryland and National by Race 1994 to 2003* 5 10 15 20 25 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Percent NAT'L White MD White NAT'L African American MD African American * 2003 National data are preliminary. Maryland’s Results for Child Well- Being 2005 18 BIRTHS TO ADOLESCENTS Indicator Definition Significance Baseline Data Data Sources Related Measures Discussion The rate of births to adolescents less than 20 years old. The rate of births ( per 1,000) for adolescents less than 15 years ( 10- 14 year olds) and for adolescents between the ages of 15 and 17, as well as those between the ages of 15 and 19, adolescents in various racial/ ethnic groups, and adolescents in various age groups. Adolescent mothers are more likely to drop out of high school, experience unem-ployment, or, if employed, earn lower wages than women who begin childbearing after age 20. Children born to teen mothers face increased risks of low birth weight, developmental problems, and poverty. BIRTHS TO ADOLESCENTS ( reported by calendar year) Maryland - Vital Statistics, Department of Health and Mental Hygiene. These data are published by jurisdiction for larger age categories. National - Federal Inter-agency Forum on Child and Family Statistics http:// childstats. gov. U. S. Census Bureau population estimates were used to calculate the 15- 17 birth rate for 2001; and the 10- 14, 15- 17, and 15- 19 birth rates for 2002 and 2003. As Maryland Vital Statistics makes these population estimates available, these birth rate figures will be updated. National comparisons and state trend data are available. Since pregnancies before age 15 are more rare, to include these data in one overall rate would reduce the rate and mask its significance. In some communities, however, the rate for under age 15 is growing and deserves separate examination. Data for 2003 indicated that Maryland’s adolescent birth rates for all age groups continue to decrease. The birth rate for 15- 19 year olds has dropped over the last decade with a decline of 31.2% since 1994. Similarly, the birth rate for 10- 14 year olds decreased 62.5% over the same time period. The national trend for all age Total live births per 1,000 women Age 10- 14 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Maryland 1.6 1.3 1.3 1.2 1.1 0.9 0.9 0.8 0.7 0.6 National 1.4 1.3 1.2 1.1 1.0 0.9 0.9 0.8 0.7 NA Age 15- 17 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Maryland 31.7 32.0 29.0 28.2 26.4 25.1 23.3 20.9 19.9 18.2 National 37.6 36.0 33.8 32.1 30.4 28.7 27.5 24.7 23.2 NA Age 15- 19 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Maryland 48.4 47.7 46.0 43.9 42.8 42.5 41.2 37.8 35.4 33.3 National 58.9 56.8 54.4 52.3 51.1 49.6 48.7 45.3 43.0 NA Maryland’s Results for Child Well- Being 2005 19 groups was also downward. Based on 2000 data, Maryland’s 15- 19 teen birth rate ranked 30th nationally. Maryland has used a multifaceted approach to prevent teen pregnancy including: health education and counseling ( abstinence, reproductive physiology, STD preven-tion - for both girls and boys), access to health care, outreach, and media. Promoting social and emotional skills, and working with families and communities to create support systems needed to maintain a balanced personal life also help youth avoid teen pregnancy. Teen Birth Rates Ages 15 to 19 Maryland and National 1994 to 2003* 10 20 30 40 50 60 70 80 90 100 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 * National 2003 data not available. Rate per 1,000 Maryland National Teen Birth Rates Ages 15 to 17 Maryland and National 1994 to 2003* 10 20 30 40 50 60 70 80 90 100 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 * National 2003 data not available. Rate per 1,000 Maryland National Teen Birth Rates Ages 10 to 14 Maryland and National 1994 to 2003* 1 2 3 4 5 6 7 8 9 10 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 * Maryland births age < 15; National 2003 data not available. Rate per 1,000 Maryland National Maryland’s Results for Child Well- Being 2005 20 Maryland’s Results for Child Well- Being 2005 21 HEALTHY CHILDREN THE GOVERNOR HEALTHY CHILDREN INDICATORS: IMMUNIZATIONS: The percent of children fully immu-nized by age two. INJURIES: The rate of child injuries that require hospitali-zation. DEATHS: The rate of child fatalities among children one year of age and older. SUBSTANCE ABUSE: The percentage of public school students who report using alcohol, tobacco or other drugs. Maryland’s Results for Child Well- Being 2005 22 IMMUNIZATIONS Indicator Definition Significance Baseline Data Data Sources Considerations Related Measures Discussion The percent of children fully immunized by age two. The percent of children 19- 35 months of age who have received the full schedule of appropriate immunizations against diphtheria, tetanus, pertussis, measles, mumps, rubella and polio. Haemophilus influenza type B ( HIB), hepatitis B, and chicken pox vaccines are also part of the basic immunization series, but coverage with these vaccines is measured separately by the National Immunization Survey. The immunization status of young children is an almost perfect predictor of avoid-ance of death, disability, or developmental delays associated with immunization-preventable diseases. IMMUNIZATION COVERAGE AT AGE 2 ( reported by survey year) The National Immunization Survey ( NIS), which is sponsored by the Centers for Disease Control and Prevention ( CDC), provides state estimates of vaccination cov-erage levels among children aged 19- 35 months. Households in all 50 states, the District of Columbia, and 27 urban areas are interviewed quarterly. In addition, pe-diatricians, family physicians, and other health care providers are also surveyed. As vaccines are introduced, immunization rates on these vaccines may need to be included, such as the HIB vaccine. Data are not yet available by jurisdiction. Maryland has developed an immunization registry ( ImmuNet) that can track current immunization status of all children up to age 18. Go to www. cha. state. md. us/ mdimmunet/ for more information. In addition, the Maryland recommended schedule for immunization changes occa-sionally. To see the current recommended schedule go to http:// www. edcp. org and click “ immunization.” According to national statistics, the percentage of children ages 19- 35 months that were fully immunized in Maryland in 2003 stood at 85%, compared to a national average of 82%. Since 1994 the total percentage of child immunizations in Maryland has ranged between 79% and 85% and equaled or exceeded the national average in all but one year ( 2000). Both the national ( Healthy People 2010) and state ( Maryland Health Improvement Plan) goal is for 90% of children age two and under to be up to date in their immunization series. Percent of children immunized by age 2 1995 1996 1997 1998 1999 2000 2001 2002 2003 Maryland 81 80 82 79 81 80 80 82 85 National 76 78 78 79 80 81 79 79 82 1994 79 75 Maryland’s Results for Child Well- Being 2005 23 Immunizations protect children from diseases that include, but are not limited to, measles, mumps, rubella ( German measles), diphtheria, tetanus, pertussis ( Whooping cough), polio, Haemophilus influenzae type b ( HIB), varicella ( Chicken pox), hepatitis B, and pneomococcal disease. They continue to be very important; current low rates of disease are due to the high rates of immunizations over the past decades. Each year the recommended childhood immunization schedule is re-viewed and updated by the Centers for Disease Control’s Advisory Committee on The Percent of Children Ages 19- 35 Months Fully Immunized Maryland and National, Survey Years 1994 to 2003 50 55 60 65 70 75 80 85 90 95 100 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Percent Maryland National Maryland’s Results for Child Well- Being 2005 24 INJURIES Indicator Definition Significance Baseline Data The rate of child injuries that require inpatient hospitalization. The rate of injuries per 1,000 children that require inpatient hospitalization in three broad injury categories: unintentional injuries ( motor vehicle or other), assaults, or self- inflicted injuries. Childhood injuries requiring inpatient hospitalization present risks of long- term illness and disability. Nationally, each year unintentional injuries disable over 92,000 children and hurt 1 in 4 children seriously enough to require medical atten-tion. These injuries cost the U. S. healthcare system $ 347 billion per year . CHILD INJURIES ( reported by calendar year) Data Sources All Maryland hospitals report hospital discharge data to the Health Services Cost Review Commission ( HSCRC). These data sets are used by the Center for Preventa-tive Health Services ( CPHS) of the Department of Health and Mental Hygiene ( DHMH) to produce standardized jurisdiction profiles that include reports on child hospitalization and death. Data on children are available by the age brackets 0- 4, 5- 9, 10- 14, and 15- 19, as well as by jurisdiction. Child injuries per 1,000 children ages 0- 19 Unintentional injuries 1995 1996 1997 1998 1999 2000 2001 All Races 4.5 4.6 4.3 3.4 4.0 3.8 3.8 African Am 5.0 5.2 4.6 3.8 4.1 3.9 3.7 White 4.4 4.3 4.2 3.2 3.9 3.9 3.8 All other races 3.4 4.0 4.0 3.3 3.8 2.6 3.8 Assaults 1995 1996 1997 1998 1999 2000 2001 All Races 0.4 0.5 0.4 0.4 0.3 0.3 0.3 African Am 1.1 1.1 1.1 0.9 0.8 0.8 0.7 White 0.1 0.2 0.2 0.2 0.1 0.2 0.1 All other races 0.2 0.2 0.2 0.4 0.2 0.1 0.2 Self- inflicted injuries 1995 1996 1997 1998 1999 2000 2001 All Races 0.4 0.4 0.3 0.3 0.3 0.3 0.3 African Am 0.4 0.4 0.3 0.3 0.2 0.2 0.2 White 0.4 0.3 0.3 0.3 0.3 0.4 0.4 All other races 0.4 0.3 0.5 0.3 0.3 0.2 0.5 2002 3.8 3.9 3.7 5.1 2002 0.4 0.8 0.2 0.4 2002 0.3 0.2 0.4 0.3 Maryland’s Results for Child Well- Being 2005 25 Discussion Injuries may be the result of unintentional or intentional events. Most unintentional injuries are related to motor vehicle/ traffic accidents, falls, fires and burns, poison-ings, choking and suffocation, and drowning. Intentional injuries include both as-saults and self- inflicted injuries. In Maryland from 1995 through 2000 the rate of unintentional injuries decreased slightly for all races, remaining stable in 2001and 2002. The unintentional injury rate for White children has declined since 1995. For African- American children the rate increased slightly from 2001 to 2002. For chil-dren of all other races the rate increased markedly. For all races, the rate of injuries resulting from assaults or which were self- inflicted increased. In 2002, injuries were between 4.9 ( African- American) and 18.5 ( White) times more likely to caused by unintentional events than by assaults and between 9.3 ( White) and 19.5 ( African- American) times more likely to be caused by uninten-tional events than by self- inflicted actions. It is estimated that as many as 90% of childhood injuries can be prevented. For every dollar spent on bike helmets, society saves $ 30. For every dollar spent on car seats, society saves $ 32, and for every dollar spent on smoke alarms, society saves $ 21. It is estimated that as many as 90% of childhood injuries can be prevented. Devoting time and resources to educational initiatives and equipment distribution can reduce the instance of injury. Although not as easily quantified, increased focus on promoting the social and emotional skills, values and support systems needed to maintain a balanced personal life and family may prevent self- inflicted injuries and assaults. Considerations It may be desirable to use multi- year averaging and trend lines as well as large age brackets in smaller jurisdictions. CPHS encourages jurisdictions to solicit additional data on specific types of injuries pertinent to local issues. It is important to note that the coding for external cause of injury is not reliable enough to indicate whether a child injury was related to abuse or neglect. Child Injuries Caused by Unintentional Injuries, Assault, or Self- inflicted Injuries, 2002* 1 2 3 4 5 6 7 8 9 10 All Races White African American All Other Races * Data not available for 2003. Rate per 1,000 Unintentional Injuries Assaults Self- inflicted Injuries Maryland’s Results for Child Well- Being 2005 26 DEATHS Indicator Definition Significance Baseline Data Data Sources Considerations The rate of deaths among children one year of age and older. The rate per 100,000 of deaths among children one year of age and older by age ( 1- 9, 10- 19) by race/ ethnicity. The indicator measures the ultimate poor health outcome for children. The rates and causes of death indicate specific risks for children of different ages, genders, and racial/ ethnic backgrounds. CHILD DEATH RATE BY AGE & RACE ( reported by calendar year) Maryland - Vital Statistics, Department of Health and Mental Hygiene; National - Office of Analysis and Epidemiology, National Center for Health Statistics, CDC, http:// wonder. cdc. gov/ mortsql. html. It may be desirable to compute multi- year averages, particularly for small jurisdic-tions and subgroups. It may be possible to develop other categories using unpub-lished data. Child deaths per 100,000 children ages 1- 19* Maryland 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 All Races 39.9 44.5 37.8 36.3 34.7 36.0 32.7 34.6 33.3 34.5 White 30.6 32.5 24.8 25.2 23.3 28.2 28.8 28.2 26.1 27.0 African Amer NA 72.9 66.5 61.6 58.9 53.9 46.4 49.3 47.4 50.9 All Other 56.7 19.8 22.4 15.4 24.2 19.7 9.6 16.4 24.1 18.1 National 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 All Races 42.9 41.8 39.9 38.0 36.3 34.9 33.9 33.6 33.5 NA White 37.9 37.6 35.9 34.8 33.5 32.7 32.1 31.9 31.9 NA African Amer 69.3 63.4 59.3 53.7 50.4 48.2 45.2 44.0 43.7 NA All Other 62.5 57.9 54.7 50.2 47.0 42.8 40.2 39.7 39.3 NA * For child deaths less than one year of age, see infant mortality; race was not broken out for African- Americans until 1995 – see graphs. Related Measures National Kids Count 2004 report publishes child death rates for children ages 1- 14. through 2001 National Kids Count 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Maryland 30 29 30 27 25 23 20 21 21 22 National 29 30 29 28 26 25 24 24 22 22 Maryland’s Results for Child Well- Being 2005 27 Discussion The leading cause of death among children ages 1- 14 remains accidents. In 2003, there were 206 deaths for persons ages 1 to 15. Fifty- nine deaths ( 28.6%) were the result of accidents. Malignancies ( cancer) ranked second. . Other causes of death for children include homicides, congenital anomalies, infectious diseases, and chronic diseases. The State continues to stress greater care to prevent fatal accidents in the home, on the road, and in schools. Moreover, in an effort to reduce the number of homicides, Maryland has enacted the toughest gun measures in the nation and police forces around the State have worked diligently with schools. Additionally, youth who de-velop the skills to participate in the cultural and civic life of their communities are less likely to become victims of violence. Child Death* Rates Ages 1 to 19 Maryland and National** 1993 to 2002 10 20 30 40 50 60 70 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Rate per 100,000 Maryland National * For deaths less than one year of age see infant mortality. Child Death* Rates Ages 1 to 19 in Maryland by Race 1996 to 2002 10 20 30 40 50 60 70 80 90 100 1996 1997 1998 1999 2000 2001 2002 Rate per 100,000 All Races White African American All Other Races * For deaths less than one year of age see infant mortality. Maryland’s Results for Child Well- Being 2005 28 SUBSTANCE ABUSE Indicator Definition Significance Baseline Data The percentage of public school students who report using alcohol, tobacco, or other drugs. Percent of public school students who report using alcohol, tobacco, or illegal drugs by type of substance and by age/ grade ( 6th, 8th, 10th, and 12th) within the last 30 days. Use of various substances poses major health risks to youth. Early use of some substances ( e. g. tobacco) is associated with later use of others. SUBSTANCE ABUSE WITHIN THE LAST 30 DAYS ( percent of students, re-ported by academic year). Cigarettes Alcohol Marijuana Maryland 1996 1998 2001 2002 1996 1998 2001 2002 1996 1998 2001 2002 6th Grade 4.6 4.2 2.5 1.3 7.9 9.1 6.3 5.0 1.8 1.8 1.2 0.8 8th Grade 17.0 14.8 10.6 6.6 27.1 26.6 22.8 16.4 11.6 10.0 10.6 6.9 10th Grade 25.1 23.9 16.6 12.7 43.7 42.9 35.0 35.0 22.4 22.7 19.8 16.7 12th Grade 32.0 28.6 25.5 19.8 52.4 48.4 47.5 44.3 27.4 24.2 22.7 21.0 Heroin Ecstasy LSD Maryland 1996 1998 2001 2002 1996 1998 2001 2002 1996 1998 2001 2002 6th Grade 0.4 0.7 0.3 0.3 0.4 0.6 0.4 0.4 0.8 0.8 0.6 0.4 8th Grade 1.6 1.8 1.1 0.7 1.9 1.3 2.4 1.4 2.9 2.6 2.2 0.8 10th Grade 1.5 2.2 1.1 1.1 2.9 3.6 4.8 3.1 5.8 5.0 3.7 2.4 12tth Grade 1.6 1.1 0.9 1.4 2.7 3.1 4.8 3.6 5.6 4.8 3.7 2.7 Cigarettes Alcohol Marijuana National 1996 1998 2001 2002 1996 1998 2001 2002 1996 1998 2001 2002 8th Grade 21.0 19.1 12.2 10.7 26.2 23.0 21.5 19.6 11.3 9.7 9.2 8.3 10th Grade 30.4 27.6 21.3 17.7 40.4 38.8 39.0 35.4 20.4 18.7 19.8 17.8 12th Grade 34.0 35.1 29.5 26.7 50.8 52.0 49.8 48.6 21.9 22.8 22.4 21.5 Heroin Ecstasy National 1996 1998 2001 2002 1996 1998 2001 2002 1996 1998 2001 2002 8th Grade 0.7 0.6 0.6 0.5 1.0 0.9 1.8 1.4 1.5 1.1 1.0 0.7 LSD 10th Grade 0.5 0.7 0.3 0.5 1.8 1.3 2.6 1.8 2.4 2.7 1.5 0.7 12th Grade 0.5 0.5 0.4 0.5 2.0 1.5 2.8 2.4 2.5 3.2 2.3 0.7 Data Sources The Maryland State Department of Education ( MSDE) administers the Maryland Adolescent Survey ( MAS) to assess information and attitudes on the nature, extent and trends in alcohol, tobacco, and drug use in middle and high school populations. Maryland’s Results for Child Well- Being 2005 29 The results of the MAS are generalizable to the population of public school stu-dents. Considerations Related Measures The annual national survey, “ Monitoring the Future,” conducted by the National Institute on Drug Abuse, gathers information on 8th, 10th, and 12th graders. Discussion Findings reported in the 2002 MAS indicate that since 1998, there has been a contin-ual decline in the use of alcohol, tobacco, and/ or other drugs. The fact that the ma-jority of our adolescents do not use any drugs is often overshadowed by the discus-sion of those adolescents who do use drugs. While approximately two- thirds of our 12th graders have tried alcohol, it is important to point out that less than 50% report using alcohol in the 30 days prior to the survey. After a significant increase in 2001 in the 8th, 10th, and 12th grade, use of Ecstasy decreased across these grades in 2002. Alcohol continues to be the most frequently used substance at each grade level throughout the entire time frame. These trends in Maryland are consistent with the findings of the 2002 Monitoring the Future Study. The 2004 Maryland Adolescent Survey was administered December 8, 2004 and the results of that survey are scheduled for release in August 2005. The survey is conducted biennially and has been designed to parallel the National Institute on Drug Abuse’s annual national survey “ Monitoring the Future.” The MAS provides information about substance abuse and risk and protective factors at the jurisdictional level. Percent of 6th, 8th, 10th, and 12th Graders Reporting Use of Cigarettes, Alcohol, and Marijuana in the Last 30 Days 10 20 30 40 50 60 70 80 1998 Cig. 2001 Cig. 2002 Cig. 1998 Alc. 2001 Alc. 2002 Alc. 1998 Mar. 2001 Mar. 2002 Mar. Percent 6th Grade 8th Grade 10th Grade 12th Grade Percent of 6th, 8th, 10th, and 12th Graders Reporting Use of Ecstasy, Heroin, and LSD in the Last 30 Days 2 4 6 8 10 12 14 16 18 20 1998 Ecst. 2001 Ecst. 2002 Ecst. 1998 Her. 2001 Her. 2002 Her. 1998 LSD 2001 LSD 2002 LSD Percent 6th Grade 8th Grade 10th Grade 12th Grade Percent of 8th Graders Reporting Substance Use in Last 30 Days, Maryland and National 2002 5 10 15 20 25 30 35 40 Cigarettes Alcohol Marijuana Ecstasy LSD Percent Maryland National Maryland’s Results for Child Well- Being 2005 30 Maryland’s Results for Child Well- Being 2005 31 CHILDREN ENTER SCHOOL READY TO LEARN THE GOVERNOR CHILDREN ENTER SCHOOL READY TO LEARN INDICATOR: KINDERGARTEN ASSESSMENT: The percent of kin-dergarten students who have reached one of three levels of readiness on the Work Sampling System Kindergarten Assessment: full readiness, approaching readiness or de-veloping readiness. Maryland’s Results for Child Well- Being 2005 32 KINDERGARTEN ASSESSMENT Indicator Definition Significance Baseline Data Percent of kindergarten students who have reached one of three levels of readiness on the Work Sampling System ™ Kindergarten Assessment: full readiness, ap-proaching readiness, or developing readiness. The three levels of readiness are based upon teacher ratings in the following seven domains: social and personal, language and literacy, mathematical thinking, scien-tific thinking, social studies, the arts, and physical development. Full readiness is defined as consistently demonstrating skills, behaviors, and abilities that are needed to meet kindergarten expectations successfully. Approaching readiness indicates that a student is inconsistently meeting those goals and requires targeted instruc-tional support. Students who are developing readiness do not successfully meet kin-dergarten readiness goals and require considerable support. Recent neuroscientific research strongly supports the belief that early learning ex-perience prior to formal education is an essential foundation for later school suc-cess. Research in how young children learn encourages the assumption that im-provement in school readiness will positively impact school performance, to be measured by the results of future assessments administered statewide to Maryland students. KINDERGARTEN ASSESSMENT ( reported by academic year) Data Sources The Work Sampling System ™ Kindergarten Assessment is administered by local public schools. Data are collected by the Maryland State Department of Education ( MSDE) and are available by jurisdiction and by individual schools. The Work Sampling System is a registered trademark of Pearson Early Learning, Inc. Full Readiness Approaching Readiness Developing Readiness Academic Year 2002 2003 2004 2002 2003 2004 2002 2003 2004 Composite 49 52 55 44 41 38 7 7 6 Social and Personal 55 60 62 36 33 31 9 8 7 Language and Literacy 36 42 45 50 46 44 14 12 11 Mathematical Thinking 40 44 49 47 43 40 13 12 11 Scientific Thinking 24 29 32 59 57 55 17 14 13 Social Studies 32 37 41 55 52 50 13 11 10 The Arts 51 58 62 42 36 34 7 5 4 Physical Development 60 66 70 35 30 28 4 3 3 Percent of students entering kindergarten demonstrating school readiness 2005 58 63 48 54 36 44 63 72 2005 35 30 41 36 53 47 32 25 2005 6 7 11 10 12 9 4 3 Maryland’s Results for Child Well- Being 2005 33 Discussion The school readiness information for school year 2004- 05 represents the fourth year that all kindergartners in the state of Maryland were rated on their readiness for school. The statewide data for the composite score reveals that 58% of entering kin-dergarten students in Maryland were rated by their teachers as “ fully ready” to do kindergarten work. 35% of entering students were at the “ approaching readiness” level and in need of targeted support in order to meet kindergarten expectations. Six percent of the students were in the “ developing readiness” category and needed con-siderable support in order to do kindergarten work successfully. Most of the support was needed in the domains of Scientific Thinking, Language and Literacy, Social Studies, and Mathematical Thinking. Compared to the school readiness baseline data collected in school year 2001- 02, the composite school readiness data for 2004- 05 show that 9% more kindergarten students came to school fully ready. There was improvement in all domains. The largest improvement area in 2004- 05 was in Language and Literacy with an increase of 12% of the students rated “ fully ready” compared to 2001- 02. Percent of Kindergarten Students Demonstrating School Readiness: Composite, Social & Personal, Language & Literacy, and Mathematical Thinking, Maryland 2005 10 20 30 40 50 60 70 Composite Social & Personal Language & Literacy Mathematical Thinking Full Readiness Approaching Readiness Developing Readiness Percent Percent of Kindergarten Students Demonstrating School Readiness: Scientific Thinking, Social Studies, The Arts, and Physical Development, Maryland 2005 10 20 30 40 50 60 70 80 Scientific Thinking Social Studies The Arts Physical Development Full Readiness Approaching Readiness Developing Readiness Maryland’s Results for Child Well- Being 2005 34 Maryland’s Results for Child Well- Being 2005 35 CHILDREN SUCCESSFUL IN SCHOOL THE GOVERNOR CHILDREN SUCCESSFUL IN SCHOOL INDICATORS: ABSENCE FROM SCHOOL: The percent of students in all grades who are absent more than 20 days annually from school. ACADEMIC PERFORMANCE The percent of public school students in grades 3 to 8 and 10 performing at ba-sic, proficient, or advanced levels in reading and mathe-matics. Students in grades 3 to 8 and 10 take the MSA in reading. Students in grades 3 to 8 and those taking a high-school- level geometry course take the MSA in math. DEMONSTRATED BASIC SKILLS: The percent of pub-lic school students in grades 9 through 12 performing at the passing level in four core subjects: algebra, biology, English 1, and government. Maryland’s Results for Child Well- Being 2005 36 ABSENCE FROM SCHOOL Indicator Definition Significance Baseline Data The percent of students absent more than 20 days of school annually. Percent of students in all grades missing more than 20 days of the school year. School attendance data are calculated as the percentage of students present in school for at least half the average school day throughout the school year. This measure is consistent with the Maryland State Department of Education ( MSDE) standard that students attend 94 percent of school days. Data are published for the elementary ( grades 1- 5), middle ( grades 6- 8), and high ( grades 9- 12) school levels. Absenteeism and truancy indicate a loss of opportunities to learn and have negative long- term consequences. High levels of school absence are associated with a higher risk of school failure, dropping out of school, delinquent behavior, substance abuse, and other high- risk behaviors. ABSENCE FROM SCHOOL ( reported by academic year) All grades — Percent absent more than 20 days 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 13.6 14.7 13.6 13.8 12.9 13.7 12.3 12.3 11.3 13.0 2004 13.1 Data Sources MSDE collects attendance data through the Maryland Report Card Performance Report. Attendance rates are reported for the State, school system, and school levels for elementary, middle, and high school levels. Considerations The current data reporting system is structured to collect statistics for absences of more than 20 days. It is important to note that these data do not differentiate be-tween students with “ excused” versus “ unexcused” absences. Local school systems have detailed data on reasons for absences. Also, the measure does not include stu-dents enrolled for fewer than 91 days during the school year. Discussion Maryland public schools recognize the significant role parents play in their chil-dren’s education. Absentee rates from school are one measure of parent- school collaboration. Between 1994 and 2003, the percentage of students missing 20 or more days changed from 13.6% to 13.2%. However, during that decade the rate fluctuated from a high of 14.7% in 1995 to a low of 11.3% in 2002. The Maryland State Board of Education’s family involvement policy, adopted in October 2001, is supportive of the fact that when schools, families, and community organizations work together to support learning, children tend to do better in school, stay in school longer, and like school more. This comprehensive family involve-ment policy is dedicated to empowering parents to become involved in their chil-dren’s education. The Board’s family involvement policy also recognizes that students with involved parents earn higher grades and test scores, enroll in higher- level programs, attend Maryland’s Results for Child Well- Being 2005 37 school regularly, pass their classes, are promoted, develop better social skills, show improved behavior, and go on to postsecondary education. Creating positive home, school, and community partnerships is essential to accomplishing the emission of successfully educating all students in Maryland. In the fall of 2003, the Maryland’s Parent Advisory Council ( M- PAC) was formed to serve in an advisory capacity to the State Department of Education and the State Board of Education on issues of parent involvement, from the development and im-plementation of policies and procedures, to parents’ rights and roles in student achievement. This group is expected to have a positive impact on every family in Maryland. The Percent of Students in all Grades Missing More Than 20 Days of the School Year in Maryland 1995 to 2004 5 10 15 20 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Percent Maryland’s Results for Child Well- Being 2005 38 ACADEMIC PERFORMANCE Indicator Definition Significance Baseline Data The percent of public school students in 3rd to 8th, and 10th grades scoring proficient or advanced on the Maryland School Assessment ( MSA). For students with signifi-cant cognitive disabilities, the Alternate Maryland School Assessment ( Alt- MSA) is used to measure student progress in reading and mathematics. The percent of public school students in 3rd to 8th grades and 10th grade performing at proficient or advanced levels in reading and mathematics. Students in grades 3 to 8 and grade 10 take the MSA in reading. Students in 3rd to 8th grades and those tak-ing a high- school- level geometry course take the MSA in math. The MSA requires students in 3rd to 8th grades to demonstrate what they know about reading and math and 10th grade students in reading. The test will produce a score that describes how well a student masters the reading and math content specified in the Maryland Content Standards. Each child will receive a score in each content area that will categorize their performance as basic, proficient, or advanced. These data will provide parents with objective information on where their child stands academically. 3rd to 8th, and 10th GRADE MARYLAND SCHOOL ASSESSMENTS - Percent of students scoring at basic, proficient or advanced levels. Data Sources Collected by the Maryland State Department of Education ( MSDE) through the Maryland School Assessment for 3rd to 8th grades and 10th grade in reading and through the High School Assessment in geometry. Data are currently reported as the percent of students achieving basic, proficient or advanced performance and are available on the State, school system, and individual school levels. Considerations The Maryland School Assessment ( MSA) was established to meet the requirements of the federal No Child Left Behind Act ( NCLB). In 2004, the MSA was adminis-tered in reading and mathematics in 3rd to 8th grades and in reading in 10th grade . All students with disabilities are tested. Beginning in test year 2004, students with significant cognitive disabilities who are pursuing an alternate course of study based on their Individualized Education Program ( IEP) took the Alt- MSA, Maryland’s alternate assessment. 2004 Reading Basic Proficient Advanced Basic Proficient Advanced 3rd Grade 29.0 58.5 12.5 27.8 52.3 19.9 5th Grade 31.6 39.8 28.6 36.9 50.4 12.7 8th Grade 36.1 43.0 20.8 54.3 28.9 16.9 10th Grade 34.0 33.8 32.2 52.0 36.2 11.8 Mathematics 4th Grade 27.9 59.3 15.8 30.4 49.9 20.0 6th Grade 31.7 37.9 30.4 49.7 39.1 11.2 7th Grade 33.0 41.1 25.9 50.2 39.7 10.1 Discussion The cornerstone of Maryland’s new accountability system is Adequate Yearly Pro- Maryland’s Results for Child Well- Being 2005 39 gress ( AYP). AYP is the measure by which MSDE tracks academic progress and makes decisions about school and school system improvement. All students are tested under the new accountability system and all student scores are reported at the school, school system, and state levels. Schools, school systems, and the State must show that students are making AYP in reading, math, and one other measure. In elementary and middle schools, the additional measure is attendance. In high schools, it is graduation rate. In addi-tion to student achievement in the aggregate, AYP must be made among eight subgroups of students: five racial/ ethnic groups ( African American, American Indian, Asian/ Pacific Islander, Hispanic, White), students with limited English proficiency, students receiving special education services, and students receiving free/ reduced price meals. If schools do not make AYP, Maryland has a process in place to help them im-prove. Schools must use their federal funds to make needed improvements. Par-ents will also have options to ensure that their children receive the high quality education to which they are entitled. These options might include transfers to higher performing schools in the area or supplemental educational services in the community, such as tutoring, after- school programs or remedial classes. Maryland School Assessment ( MSA) Reading Achievement Levels for 3rd, 5th, 8th, and 10th Grade Students, 2004 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Basic Proficient Advanced Percent 3rd Grade 5th Grade 8th Grade 10th Grade Maryland School Assessment ( MSA) Mathematics Achievement Levels for 3rd, 5th, 8th, and 10th* Grade Students, 2004 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Basic Proficient Advanced 3rd Grade 5th Grade 8th Grade 10th Grade Percent eometry is 10th Grade Mathematics Assessment Maryland’s Results for Child Well- Being 2005 40 DEMONSTRATED BASIC SKILLS Indicator Definition Significance Baseline Data The percent of high school students demonstrating basic skills at the passing level on each of the four Maryland High School Assessments ( HSA). The percent of public school students in grades 9 through 12 performing at the pass-ing level in four core subjects: English 1 ( 10th grade), government, algebra, and biology. Students take each test whenever they complete the course. For example, some students may take algebra in the seventh grade while others may take it until tenth grade. Beginning with the graduating class of 2009 ( students entering grade 9 in fall 2005), students are required to earn a satisfactory score on the HSA in order to earn a Maryland High School Diploma. This indicator replaces the Maryland Functional Tests as of 2004. The achievement of minimum academic standards affects graduation, adult achieve-ment, and life skills. HIGH SCHOOL ASSESSMENTS – Percent of public school students scoring at the passing level for each of the four assessments ( reported by academic year). Data Sources Collected by the Maryland State Department of Education ( MSDE) through the Maryland High School Assessments. Data on the percent passing and the number exempt are available at the end of grade ten. Discussion In August 2003, the Maryland State Board of Education decided to discontinue the use of the Maryland Functional Tests which had been in use since the 1980’ s. The graduating class of 2004 was the last class of students required to pass the Maryland Functional Tests in order to earn a diploma. The Maryland High School Assess-ments were developed in the early 2000’ s to replace the Functional Tests. They are aligned with the Maryland Content Standards and ensure that Maryland’s high school graduates are competent in the four content areas: algebra, biology, English at the 9th grade level, and government. Beginning with the graduating class of 2009 ( students entering grade 9 in fall 2005), students are required to earn a satisfactory score on the HSA in order to earn a Maryland High School diploma. Results from the first three years of testing ( 2002, 2003 and 2004) indicate that there has been an increase in the percent of students passing the tests. Algebra pass rates increased from 52.1% to 58.8%; biology pass rates increased from 54.5% to 60.9%; English 1 pass rates increased from 43.6% to 53.0%; and, government pass rates increased from 57.3% to 65.9%. Percent Passing Subject Area 2004 Algebra 58.8 Biology 60.9 English 1 53.0 Government 65.9 2003 53.2 54.3 39.8 60.2 2002 52.1 54.5 43.6 57.3 Maryland’s Results for Child Well- Being 2005 41 Maryland High School Assessments ( HSA) Passing Percents for High School Students, 2002- 2004 10 20 30 40 50 60 70 Algebra Biology English 1 Government High School Assessment Areas Percent Passing 2002 2003 2004 Maryland’s Results for Child Well- Being 2005 42 Maryland’s Results for Child Well- Being 2005 43 CHILDREN COMPLETING SCHOOL THE GOVERNOR CHILDREN COMPLETING SCHOOL INDICATORS: DROPOUT RATE: The percent of students in grades 9 through 12 who drop out of school in a single year. HIGH SCHOOL PROGRAM COMPLETION: The per-cent of high school graduates who complete minimum course requirements needed for career and technology pro-grams, or requirements needed to enter the University of Maryland, or who complete both. HIGH SCHOOL DIPLOMA: The percent of persons 25 years of age and over with a high school diploma or equivalent. GRADUATION/ SCHOOL COMPLETION OF CHIL-DREN WITH EMOTIONAL DISTURBANCES: The per-cent of children with Emotional Disturbances who gradu-ate from or complete high school. Maryland’s Results for Child Well- Being 2005 44 DROPOUT RATE Indicator Definition Significance The percent of students in grades nine through twelve who drop out of school in a single year. Percent of public school students in 9th through 12th grade who withdrew from school before graduation or before completing a Maryland approved educational program during the July to June academic year. Failure to complete high school is closely linked with decreased employment oppor-tunities, low pay, and limited paths to advancement. Baseline Data DROPOUT RATE ( percent of students, reported by academic year) Maryland - Percent Dropouts ( grades 9- 12) 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 5.0 4.6 4.7 4.1 4.2 3.9 3.9 3.7 3.4 3.9 National - Percent Dropouts ( grades 10- 12) 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 5.7 5.0 4.6 4.8 5.0 4.8 5.0 NA NA NA Data Sources Maryland data are collected by the Maryland State Department of Education ( MSDE) through the Maryland School Performance Program for grades 9 through 12. Data are available on the State, school system, and school levels. National Source: U. S. Department of Education National Center for Educational Statistics, Dropout Rates in the United States. Considerations The dropout rate is reported for grades 9- 12. Data on dropout rates are not collected for individual students across school years. Related Measures Local school systems have data on the various reasons students drop out of school. These reasons often include expulsion, pregnancy, and parenthood. Additionally, the U. S. Census Bureau collects two related measures: people ( age 20- 24) who have not completed high school and teenagers ( age 16- 19) who are not enrolled in school and are not high school graduates. Discussion Research has identified four major categories of factors that increase the potential for a student to drop out of school. The four categories list risk factors that are school- related, student- related, community- related, and family- related. The potential for student dropout increases as the combination of risk factors becomes more multi- faceted. Poor academic performance is considered to be the strongest of these factors. The United States Department of Education annual dropout report states that students who repeated one or more grades are twice as likely to drop out as those who have never been retained. Maryland’s Results for Child Well- Being 2005 45 Those who repeated more than one grade were four times as likely to leave school before completion. Student related factors include personal problems such as substance abuse, pregnancy, and parenthood. These personal problems lead to behavior problems including truancy, absenteeism, tardiness, suspension, and ultimately expulsion. Maryland has in place intensive student supports such as counseling, advocacy, psychological services, and health services that help students cope with their personal problems and increase their academic performance. Both the degree and nature of family support are critical in keeping students in school. Factors such as stressful/ unstable home life, single parent households, poor education of parents, socioeconomic status, and a primary language other than English increase the likelihood of a student dropping out of school. Of the community- related factors, poverty is the strongest predictor of the likelihood that a student may drop out of school. Maryland’s dropout rate is one of the lowest in the nation. Since 1993, there has been a steady improvement in Maryland’s dropout rate. In 1993, Maryland’s dropout rate was 5.4%. In 2004 the rate is 3.9%, a 28% decline over the 1993 level. Maryland’s schools have made a concerted effort in the last 10 years to create a team approach to the dropout Dropout Rate* Maryland and National Percent of Students Leaving School 1995 to 2004 2 4 6 8 10 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Percent Maryland National * Maryland-% of students grades 9- 12 who withdrew from school before graduation or completing an approved educational program. National-% of students enrolled in grades 10- 12 one year earlier not enrolled and not graduated in the year for which data presented; national data unavailable 2002 - 2004. Maryland’s Results for Child Well- Being 2005 46 HIGH SCHOOL PROGRAM COMPLETION Indicator The percent of high school graduates who complete minimum course requirements needed for career and technology programs, or requirements needed to enter the University of Maryland, or who complete both. Significance The completion of program requirements indicates students’ potential readiness for post- secondary education and/ or employment. Baseline Data HIGH SCHOOL PROGRAM COMPLETION – Percent of students who com-plete the various post- secondary requirements ( reported by academic year). University System of Maryland Career & Technology Education Programs Both 1993 46.0 15.6 2.5 1994 47.7 14.7 3.4 1995 49.7 13.1 3.7 1996 50.8 12.7 5.0 1997 53.1 14.3 5.4 1998 57.6 14.2 6.8 1999 58.3 14.3 8.7 2000 57.7 14.2 9.7 2001 57.8 14.6 10.7 2002 52.2 15.9 11.3 2003 54.1 15.3 10.8 2004 55.7 14.7 10.3 Data Sources Data are collected by the Maryland State Department of Education ( MSDE) through the Maryland School Performance Program ( MSPP). Data are available on the State, school system, and school levels at http:// mdreportcard. org. Considerations It is important to note that the minimum required course work at the passing level might not be sufficient to predict success at the college level. Discussion Increasingly, students who complete state- approved Career and Technology Educa-tion ( CTE) programs are also meeting the requirements for entry into the University of Maryland System. These students, known as “ dual- completers,” have been in-creasing at about 10 times the rate of overall growth in the CTE programs. It ap-pears that more students who are preparing to enter directly into four- year colleges are finding value in acquiring the knowledge and skills gained by completing a CTE program. Data from the 2004 High School Graduate Survey show that Maryland graduates continue to set high expectations for themselves with 83.8% of the Class of 2004 Maryland’s Results for Child Well- Being 2005 47 planning on entering directly into some form of higher education. This rate is up from 78.8% six years ago. The same percentage of students are planning to work while they attend college ( 19.5% ). This information is available on- line for each Local School System and each individual school in the MSPP Report Card refer-enced above. In terms of academic preparation, Maryland’s average Scholastic Aptitude Test ( SAT) verbal score for the Class of 2004 rose to 511, and its average math score remained steady at 515 as the number of test takers ( 68%) continued to climb. Maryland’s composite average of 1026 represents a 12- point jump since 1992. Among the state’s recent graduates, the number of Hispanic students taking the SAT increased by 14.6% and the number of African American students by 9.0%. Participation and scores in the College Board’s Advanced Placement ( AP) program increased for Maryland students overall and for all subgroups. Exams are scored on a five- point scale and used by many colleges to award course credit or placement into advanced college credit. The number of Maryland students receiving grades 3 to 5, the high- level scores, increased by nearly 4%. AP participation and scoring among ethnic minority groups also improved. The number of African American students taking the test jumped 14 percent, while the number of Hispanic students achieving a high score jumped nearly 18 percent. Percent of Maryland High School Students who Complete Requirements to Enter University System of Maryland, Career & Technology Programs or Both, 1995 to 2004 10 20 30 40 50 60 70 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Percent University of Md Career & Technolgy Both Maryland’s Results for Child Well- Being 2005 48 HIGH SCHOOL DIPLOMA Indicator Definition Significance The percent of persons 25 years of age and over with a high school diploma or equivalent. The percent of all persons 25 years of age and over residing in Maryland who have a high school diploma or equivalent. Completing high school is closely linked with increased employment opportunities, higher pay, and expanded paths to advancement. Baseline Data EDUCATIONAL ATTAINMENT - Percent of persons 25 years and over with a high school diploma or equivalency ( reported by calendar year) 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Maryland 82.0 84.6 84.7 84.7 84.7 85.7 88.1 87.5 87.6 87.4 National 81.7 81.7 82.1 82.8 83.4 84.1 84.1 84.1 84.6 85.2 Data Sources U. S. Census - Current Population Survey data for Maryland are from Table 13 Education Attainment in the United States ( http:// www. census. gov/ population/ www/ socdemo/ educ- attn. html). Considerations The Census provides the data once every ten years. Mid- decade data are made available through Current Population Reports from the U. S. Bureau of the Census. Related Measures The percent of young adults, ages 16 to 24, who are currently enrolled in high school and have completed high school, either by obtaining a diploma or an alterna-tive credential such as a General Education Development ( GED). Discussion In Maryland and nationally, the percentage of adults 25 years old and over with a high school diploma or an equivalent credential has increased steadily. Every year from 1991 to 2004, Maryland has equaled or exceeded the national percentage. This is important because obtaining a high school diploma or its equivalent is a measure of the extent to which these adults have mastered the basic reading, writing and math skills needed to function in the 21st century. It also represents the extent to which adults 25 years and over have completed a prerequisite for many entry-level jobs, as well as higher education. High school graduates earn substantially more than persons who leave high school without graduating. Completion rates for African Americans have risen from 72% in 1972 to 89% in 2004. Completion rates have also increased among Whites, but to a lesser extent, resulting in a narrowing gap between African American and White rates over time. Hispanics have had much lower high school completion rates than either African Americans or Whites since the 1970’ s. As large numbers of immigrants have entered this country in recent years, there is a concern that many have not completed the equivalent of a high school education. Without a high school diploma or its equivalent, these adults will be less prepared to Maryland’s Results for Child Well- Being 2005 49 enter and/ or progress in the 21st century workforce. Therefore, we should continue to offer a variety of educational programs to prepare them for obtaining a diploma or GED. Percent of Persons 25 Years Old and Over With High School Diploma or Equivalent, Maryland and National 1995 to 2004 * 50 55 60 65 70 75 80 85 90 95 100 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Maryland National Percent Maryland’s Results for Child Well- Being 2005 50 GRADUATION/ SCHOOL COMPLETION OF CHILDREN WITH EMOTIONAL DISTURBANCES ( ED) Indicator Percent of children with Emotional Disturbances ( ED) who graduate from or com-plete high school. Prior to the passage of IDEA, Emotional Disturbance was re-ferred to as Serious Emotional Disturbance ( SED). Definition Percent of children with ED who exit special education by graduating or completing school. The denominator does not include those students with ED who exited the program to return to general education or to transfer to another program. The de-nominator does include those students who reached maximum age, dropped out, were expelled ( 1994- 1997), or exited with a diploma or certificate. Significance High school graduation/ completion is an indicator of adequate functioning for chil-dren with mental illness. The National Mental Health Association found that chil-dren with emotional disturbances have the highest school dropout rate of any group of children with disabilities ( The National Mental Health Associations’ 1993 Re-port, “ All Systems Failure”). Baseline Data GRADUATION/ COMPLETION RATE - Exit data ( percent of students with disabilities diagnosed with emotional disturbance, reported by calendar year) 1996 1997 1998 1999 2000 2001 2002 2003 Maryland 53.5 51.0 54.4 61.2 61.4 55.3 57.8 56.8 National 42.6 44.4 46.5 49.2 48.4 47.2 53.4 54.6 2004 56.1 NA 1995 50.9 43.0 Data Sources Maryland State Department of Education ( MSDE), Special Services Information System ( SSIS) Exit Data on the reasons students exited special education. Considerations Several factors must be considered regarding school identification of children with ED: differing diagnostic procedures and populations across counties affect enroll-ments; and, other characteristics of the population and available resources also af-fect enrollment and school completion. Related Measures Consideration was also given to the number of children receiving mental health services. These data are limited in availability. Further, it was recognized that it would be difficult to determine whether an increase in this number would be consid-ered positive or negative in terms of children’s outcomes. Discussion The number of students with ED receiving a diploma or certificate has decreased less then 1 percent from the 2002- 2003 school year to 2003- 2004 school year. The 2001- 2002 national data indicate that Maryland’s students with disabilities, includ-ing students with ED, continue to exceed the national percentage of students with disabilities receiving diplomas or certificates. In an effort to increase the graduation rate for students with ED and to enhance the quality of life for students and their families, the Maryland State Department of Education ( MSDE) has taken a number of steps to provide comprehensive support to families, school systems, and communities. These steps include assisting local schools in the educational development of children and youth with ED, fostering Maryland’s Results for Child Well- Being 2005 51 better interagency collaboration, and providing technical assistance to local school systems and state- operated programs to assure appropriate and necessary staffing for educational services. Many of Maryland’s schools have adopted a systems approach to enhancing the ca-pacity of schools to sustain the use of effective practices for all students through the use of Positive Behavioral Interventions and Supports ( PBIS). This approach assists schools in moving toward school- wide behavior systems that address the entire school - all students in all venues: the classroom, areas outside the classroom ( hallway, restroom, cafeteria, and playgrounds), and the individual students with challenging behaviors. These systems define school rules and expectations, provide training about the rules, and offer feedback through acknowledgements and correc-tions. PBIS is a team- based process for systemic problem solving and planning. It is an approach to create an environment within which school- based teams of educators are provided training in systems change, effective management principles and practices and applications of research- validated instruction and management practices. This past summer, almost 80 schools were trained in PBIS and over 200 school’s have been trained since 1999. Percent of Children with Serious Emotional Disturbances who Exit Special Education* by Graduating or Completing School 1996 to 2004 10 20 30 40 50 60 70 1996 1997 1998 1999 2000 2001 2002 2003 2004 Percent * The denominator excludes those students with SED who exited the program to return to general education or to transfer to another program. Maryland’s Results for Child Well- Being 2005 52 Maryland’s Results for Child Well- Being 2005 53 CHILDREN SAFE IN THEIR FAMILIES AND COMMUNITIES THE GOVERNOR CHILDREN SAFE IN THEIR FAMILIES AND COMMUNITIES INDICATORS: ABUSE OR NEGLECT: The rate of child abuse or neglect investigations ruled as indicated or unsubstantiated. DEATHS DUE TO INJURY: The rate of injury- related deaths to children. JUVENILE VIOLENT OFFENSE ARRESTS: The rate of arrests of youth ages 10- 17 for violent offenses. JUVENILE SERIOUS NON- VIOLENT OFFENSE ARRESTS: The rate of arrests of youth ages 10- 17 for serious non- violent offenses. DOMESTIC VIOLENCE: The rate of victims receiving domestic violence services through community- based programs funded by the Department of Human Resources. Maryland’s Results for Child Well- Being 2005 54 ABUSE OR NEGLECT Indicator Definition Significance The rate of investigations of child abuse or neglect ruled as indicated or unsubstanti-ated. Rate ( per 1,000 children under 18) of child abuse or neglect Child Protective Ser-vice investigations ruled “ indicated” ( where credible evidence is not satisfactorily refuted) or “ unsubstantiated” ( where insufficient evidence is found to support a finding as either indicated or ruled out). The indicator measures the extent to which important adults threaten children’s se-curity. Child abuse or neglect can result in physical harm, developmental delays, behavioral problems, or death. Abused and neglected children are at greater risk for delinquency and mistreatment of their own children. Baseline Data RATES OF INDICATED AND UNSUBSTANTIATED CHILD ABUSE AND NEGLECT ( reported by state fiscal year) Rate per 1,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 Indicated 7.6 7.2 6.9 6.2 6.3 6.2 5.8 5.5 5.3 Unsubstantiated 6.1 6.0 6.4 6.0 6.3 5.9 6.0 6.3 6.1 Total 13.7 13.2 13.3 12.3 12.6 12.1 11.8 11.8 11.4 2004 4.6 5.5 10.1 Data Sources The Department of Human Resources ( DHR) Client Information System ( CIS): data are available by jurisdiction and by type of abuse. DHR/ CIS does not track the number of investigations ruled out because state law requires that they be ex-punged. At the State level investigations are counted by household, not by an indi-vidual child; consequently statewide data on individual children involved in CPS investigations are not available. Data have not been available by child, age, gender, race/ ethnicity, maltreatment type, or relationship of perpetrator to victim. Recent changes to the law permit the State to begin to collect these data. Considerations The indicator represents a conservative estimate of the true incidence of abuse or neglect. When evidence is insufficient, but there is a suspicion that maltreatment did occur, the incident is classified as unsubstantiated. In addition, an unknown amount of abuse and neglect is never reported to authorities. Furthermore, a higher number of incident- based reports can reflect improvements in reporting systems rather than increases in incidents. Related Measures Both domestic violence and substance abuse are related to the risk of child maltreat-ment. Discussion The total number of investigations of alleged child abuse and neglect increased less than one percent in Maryland during FY2003. The rate per 1,000 of indicated re-ports decreased slightly, continuing the trend from FY1995 to FY2003. The rate per 1,000 of unsubstantiated reports of child abuse and neglect has remained essen-tially stable over the same time period. Maryland’s Results for Child Well- Being 2005 55 Investigation of allegations of child abuse and neglect is only the first step in pro-tecting children from continued abuse and neglect. Ongoing child protective ser-vices and family preservation programs are vital in helping families build sufficient supports to prevent the recurrence of maltreatment. Low worker- to- family ratios and intense service provision appear to be effective in preventing new incidents of child abuse and neglect, thereby reducing the need to place children outside of their homes. The need to protect Maryland’s children from abuse and neglect continues. When counseling, substance abuse treatment, parenting classes, and other services are unsuccessful in creating a safe home environment for a child, it becomes necessary to find an alternative arrangement. The first choice for alternative living arrange-ments is with relatives. When that is not possible, children are placed with foster parents until a more permanent living arrangement can be found. Maryland has begun several initiatives to create a safer living environment for children likely to be removed from the home and have expedited finding more permanent alternative living arrangements. Child Abuse and Neglect: Rate of Indicated and Unsubstantiated Cases, State Fiscal Years 1995 to 2004 2 4 6 8 10 12 14 16 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Rate per 1,000 Indicated Unsubstantiated Total Maryland’s Results for Child Well- Being 2005 56 DEATHS DUE TO INJURY Indicator Definition Significance The rate of injury- related deaths to children. The rate per 100,000 of injury- related deaths to children ages 0- 19, in three broad injury categories: accidents ( motor vehicle or other), homicide, or suicide. The indicator is associated with social, economic, and environmental threats to a child’s life. For every childhood death caused by injury, there are approximately 34 hospitalizations, 1,000 emergency department visits, many more visits to private physicians and school nurses, and an even larger number of injuries treated at home ( CDC). Baseline Data CHILD DEATHS DUE TO INJURIES ( reported by calendar year), ages 0- 19 Deaths due to injuries per 100,000 children ages 0- 19 years. All races 1996 1997 1998 1999* 2000 2001 Accidents 12.3 11.0 10.8 12.1 9.7 11.7 Homicide 8.4 8.0 8.6 7.5 5.8 6.3 Suicide 1.8 1.6 1.8 2.1 2.3 2.0 African American 1996 1997 1998 1999* 2000 2001 Accidents 17.6 15.5 13.2 11.4 11.4 11.6 Homicide 23.7 22.2 22.4 19.5 15.0 16.2 Suicide 0.9 1.1 1.3 2.1 2.5 1.6 White 1996 1997 1998 1999* 2000 2001 Accidents 10.4 9.3 9.4 13.2 9.8 11.9 Homicide 1.4 1.0 1.9 1.5 1.6 1.2 Suicide 2.1 2.0 2.1 2.2 2.5 2.5 All other races 1996 1997 1998 1999* 2000 2001 Accidents 3.2 3.1 13.5 2.8 3.5 6.1 Homicide 1.6 7.7 6.0 5.7 0.7 3.7 Suicide 3.2 0.0 0.0 0.0 0.7 0.0 2002 10.7 7.2 2.3 2002 13.0 17.7 1.8 2002 9.4 1.8 2.6 2002 10.8 4.0 1.3 2003 11.3 7.1 1.9 2003 11.4 18.3 0.8 2003 7.2 1.6 2.4 2003 6.6 1.3 2.6 * In 1999 the event coding system shifted from version 9 to version 10 of the International Classification of Diseases ( ICD). The injury events tracked for this indicator are highly comparable between the ICD 9 and 10 coding systems, therefore, the trends retain continuity throughout the years presented. Data Sources Data on child fatalities are provided by the Maryland Office of Vital Statistics and the Department of Health and Mental Hygiene. These data sets are used by the cen-ter for Preventive Health Services ( CPHS) of the Department of Health and Mental Hygiene ( DHMH) to produce standardized county profiles that include reports on child hospitalization and death. Maryland’s Results for Child Well- Being 2005 57 Considerations It may be desirable to use multi- year averaging and trend lines as well as large age groups in small jurisdictions. Related Measures Data on all child fatalities may be found in the “ Healthy Children” section. Discussion Nationally, unintentional injuries are the leading cause of death in children 1 to 19 years of age. However, there is variation between the 1- 14 and 15- 19 age groups as to the type of unintentional injuries most often found. Injuries from motor vehicles are the primary cause of death among 1- 14 year olds. For 15- 19 year olds, injuries from motor vehicles and fire arms are the primary causes of deaths. Safe Kids estimated that up to 90% of unintentional injuries are preventable. Injury prevention education such as bicycle helmets, car safety seats and smoke alarms are inexpensive interventions that save lives ( Department of Health and Human Ser-vices). In Maryland accidents are the leading cause of death for all races. For the race cate-gories White and all other races, accidents are also the leading cause of death. However, for African American youth, homicide continues to be the leading cause of death caused by injuries. The African American rate has decreased from 23.7 per 100,000 children 0- 19 years in 1996 to 15.0 per 100,000 in 2001 and then increased to 18.3 in 2003. The rate of child death due to homicide for Maryland African American youth, however, is11.4 times greater that for White youth and 14.1 times greater than for youth of all other races. Although the rate of death from suicide is low in Maryland, the rate for White youth is 3 times that of African American youth. Child Death Rates Due to Accidents Age 19 and Under by Race 1996 to 2003 5 10 15 20 25 30 35 1996 1997 1998 1999 2000 2001 2002 2003 All races White African American All other races Rate per 100,000 Child Death Rates Due to Homicide Age 19 and Under by Race 1996 to 2003 5 10 15 20 25 1996 1997 1998 1999 2000 2001 2002 2003 Rate per 100,000 All Races White African American All Other Races Child Death Rates Due to Suicide Age 19 and Under by Race 1996 to 2003 3 6 9 12 15 1996 1997 1998 1999 2000 2001 2002 2003 Rate per 100,000 All Races White African American All Other Races Maryland’s Results for Child Well- Being 2005 58 JUVENILE VIOLENT OFFENSE ARRESTS Indicator Definition Significance The rate of arrests of youth ages 10- 17 for violent offenses. The rate per 100,000 of arrests of youth ages 10- 17 for violent criminal offenses: murder, forcible rape, robbery, and aggravated assault. Involvement in violent offenses increases the risk of injury or death. Risk factors for juvenile delinquency include a lack of educational and job training opportunities, poverty, family violence, and inadequate supervision. Poor school performance, including absence from school, and falling behind in one or more grade levels, in-creases the likelihood of involvement in delinquent activity. Baseline Data JUVENILE VIOLENT OFFENSE ARRESTS: non- negligent manslaughter, forcible rape, robbery, and felonious assault ( reported by calendar year). Rate of arrests per 100,000 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Age 10- 14 350 353 333 373 355 308 300 307 305 284 Age 15- 17 1,257 1,239 1,250 1,340 1,177 929 879 912 891 834 Age 10- 17 668 666 661 722 655 535 510 524 515 482 2003 274 891 499 Data Sources Maryland State Police Uniform Crime Report ( UCR), Violent Crime Arrests. Age groups: 9 years or younger, 10- 12, 13- 14, 15, 16, 17, all juveniles. Data are also broken out separately for 18 and 19 year- olds and are reported by age, type of crime, county, and municipality. Considerations The indicator measures the number of incidents and may include repeated arrests of the same individual for different offenses within a given year, whereas the denomi-nator is the population estimate for ages 10- 17. It is recommended that an overall offense rate be included, as some counties will have small numbers. Localities may also want to use five- year averages for greater reporting accuracy. Related Measures Department of Juvenile Services ( DJS) intake for violent offenses data are also available. Discussion Ten year trend data ( 1993 to 2003) show that among 10- 17 year olds the rate of violent offense arrests for 2003 ( 499 per 100,000) has declined by 25.3% from the 1993 level ( 668 per 100,000). There was also a 21.7% decrease in the violent of-fense arrests for 10- 14 year olds ( 350 to 274 per 100,000) and a 29.1% decrease for the 15- 17 year olds ( 1,257 to 891 per 100,000) between 1993 and 2003. As displayed in the graph, the rate of violent offenses peaked for both 10- 14 year olds ( 373 per 100,000) and 10- 17 year olds ( 1,340 per 100,000) in 1996. The drop in the violent offense rate over the years has been more pronounced for the 15- 17 age group than the 10- 14 age group. Even so, the rate for 15- 17 year olds is 3.3 times higher in 2003 than for the 10- 14 year olds. Maryland’s Results for Child Well- Being 2005 59 Juvenile Violent Offense Rates Ages 10- 14 and 15- 17 in Maryland 1994 to 2003 200 400 600 800 1000 1200 1400 1600 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Rate per 100,000 Ages 10- 14 Ages 15- 17 Maryland’s Results for Child Well- Being 2005 60 JUVENILE SERIOUS NON- VIOLENT OFFENSE ARRESTS Indicator Definition Significance The rate of arrests of youth ages 10- 17 for serious non- violent offenses. The rate per 100,000 of arrests of youth ages 10- 17 for serious non- violent criminal offenses: breaking or entering, larceny, motor vehicle theft. Risk factors for juvenile delinquency include a lack of educational and job training opportunities, poverty, family violence, and inadequate supervision. Poor school performance, including absence from school and falling behind one or more grade levels, increases the likelihood of involvement in delinquent activity. Baseline Data JUVENILE SERIOUS NON- VIOLENT OFFENSE ARRESTS: breaking and entering, larceny/ theft, and motor vehicle theft ( reported by calendar year). Data Sources Maryland State Police Uniform Crime Report ( UCR), Part I offenses, 2000. Age groups: 9 years or younger, 10- 12, 13- 14, 15, 16- 17, and all juveniles. Data are also broken out separately for 18 and 19 year- olds. Data reported by age, type of crime, county and municipality. Considerations The indicator measures the number of incidents and may include repeated arrests of the same individual for different offenses within a given year, whereas the popula-tion is the individual count for ages 10- 17. There also may be high variability in law enforcement practices across jurisdictions. It is recommended that an overall of-fense rate be included, as some counties will have small numbers. Counties may also want to use five- year averages for greater reporting accuracy. Discussion Trend data from 1993 through 2003 indicate that the rate of serious non- violent juvenile ( ages 10- 17) arrests has declined from 2,670 to 1,869 per 100,000, a 30.0% decrease. Since reaching a peak in 1994, there has been a steady decline in non-violent offense arrests until 2003 when the rates increased for both 10- 14 and 15- 17 year olds. Across the years, the arrest rate for the 10- 14 year olds decreased 32.0% and the rates for the 15- 17 year olds decreased 30.4%. From 1993 through 2003, the rate for 15- 17 year olds has averaged 2.8 times that of the rate for 10- 14 year olds. Since 2001, the ratio has increased slightly to 3.0. While the rates for both groups have been decreasing, the increased ratio suggests that gap in the rates between the two groups is widening. 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Age 10- 14 1,615 1,780 1,610 1,712 1,599 1,370 1,235 1,204 1,064 1,004 Age 15- 17 4,620 5,113 4,665 4,743 4,317 3,899 3,373 3,404 3,190 3,079 Age 10- 17 2,670 2,957 2,701 2,806 2,594 2,278 2,012 1,993 1,826 1,751 Rate of arrests per 100,000 2003 1,098 3,216 1,869 Maryland’s Results for Child Well- Being 2005 61 Juvenile Non- Violent Offense Rates Ages 10- 14 and 15- 17 in Maryland 1994 to 2003 1000 2000 3000 4000 5000 6000 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Rate per 100,000 Ages 10- 14 Ages 15- 17 Maryland’s Results for Child Well- Being 2005 62 DOMESTIC VIOLENCE Indicator Definition Rate of victims receiving domestic violence services through community- based programs funded by the Department of Human Resources ( DHR). Rate of victims ( adults and minor children) receiving domestic violence services through community- based programs funded by the Department of Human Re-sources ( DHR) per 100,000 households ( estimated) in Maryland. Domestic violence impacts a child’s ability to be safe at home and in the commu-nity. Children who grow up in violent homes exhibit a higher incidence of social, emotional, and behavioral problems than other children. These children also are at greater risk than other children for delinquency and mistreatment of their own chil-dren. Baseline Data DOMESTIC VIOLENCE ( reported by fiscal year) Victims receiving Domestic Violence Services. Rate per 100,000.* 1995 1996 1997 1998 1999 2000 2001 2002 2003 337 301 337 342 312 499 490 557 607 2004 683 Data Sources Department of Human Resources ( DHR), Community Services Administration ( CSA), Office of Victim Services ( OVS). The data are collected from statistical reports submitted to OVS by the community- based service providers. The providers sign and submit reports on a monthly basis. * Rate based on estimated number of households in Maryland Considerations These data provide incomplete information regarding the actual incidence of do-mestic violence and provision of service in Maryland. For example, victims may report incidents to police but not seek services from community- based service pro-viders funded by DHR. There may also be victims who seek services from more than one service provider and are, therefore, counted more than once in the data. Other programs/ entities also serving domestic violence victims, but not funded by DHR, do exist in the community and do not report their data to DHR. Discussion The rate of victims receiving domestic violence services remained relatively stable from 1995 to 1999 with rates ranging from 301 per 100,000 in 1996 to 342 per 100,000 in 1998. From 2000 to 2004, the rate of victims receiving domestic vio-lence services grew by 36.9%, from 499 per 100,000 in 2000 to 607 per 100,000 in 2004. One reason for this growth is that DHR has increased the funding for com-munity- based domestic violence programs during the last few years. Another may be the downturn in the economy. Domestic violence not only affects those who are being abused, but also impacts the children who witness the acts. Ninety percent of children from violent homes di-rectly witness attacks even though parents think they are unaware of the violence. Significance Maryland’s Results for Child Well- Being 2005 63 Seventy percent of men who abuse their female partners also abuse their children. Child abuse is 15 times more likely to occur in families where domestic violence is present. In the context of domestic violence, the younger the child, the greater the threat to healthy development. As the child grows older, years of witnessing domestic vio-lence may take their toll in varying ways, depending on the age of the child. Younger children may blame themselves, believing that they are the cause of the violence. They may also exhibit behavior and emotional problems such as becom-ing withdrawn, experiencing eating and sleeping difficulty, and having concentra-tion problems. Pre- adolescent children may develop a loss of interest in social ac-tivities and a low self- concept. Other common behavior includes temper tantrums, irritability, and frequent fighting at school and at home. Dropping out of school, delinquency, and substance abuse are common outcomes of an adolescent child who has witnessed domestic violence ( Effects of Domestic Violence on Children and Adolescents: An Overview - www. aaets. org/ arts/ art8. htm). Because domestic violence is a learned behavior, the ultimate risk for children who witness abuse is that they will grow up to be the next generation of batterers and battered victims. Rate* of Victims Receiving Domestic Violence Services in Maryland 1995 to 2004 100 150 200 250 300 350 400 450 500 550 600 650 700 750 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Rate per 100,000 Households * Based on estimated number of households in Maryland Maryland’s Results for Child Well- Being 2005 64 Maryland’s Results for Child Well- Being 2005 65 STABLE AND ECONOMICALLY INDEPENDENT FAMILIES THE GOVERNOR STABLE AND ECONOMICALLY INDEPENDENT FAMILIES INDICATORS: CHILD POVERTY: The percent of children under 18 whose families have incomes below the poverty level. SINGLE PARENT HOUSEHOLDS: The percent of all households that are headed by a single parent. OUT- OF- HOME PLACEMENTS: The rate of children placed in out- of- home care. PERMANENT PLACEMENTS: The percent of children who leave out- of- home care for a more permanent living arrangement. HOMELESS ADULTS AND CHILDREN: The rate of homeless adults and children per 100,000 Maryland residents served by programs funded by the Department of Human Resources and other shelter providers. Maryland’s Results for Child Well- Being 2005 66 CHILD POVERTY Indicator Definition Percent of children under 18 whose families have incomes below the poverty level. Percentage of people under 18 ( SAIPE statistic) or related children under 18 ( CPS statistic) whose families have incomes below the U. S. poverty threshold, as defined by the U. S. Office of Management and Budget. “ Related children” include the householder’s children by birth, marriage, or adoption under age 18 as well as other persons under 18, such as nieces or nephews, who are related to the family head. Children who grow up in poverty are more likely to have unmet nutritional needs, live in substandard housing, be victims of crime and violence, lack basic health care, and have unequal access to educational opportunities. Significance Baseline Data CHILD POVERTY ( Reported by calendar year) Data Sources This report includes two estimates of child poverty: Current Population Survey ( CPS) - weighted count and Small Area Income and Poverty Estimates program ( SAIPE). Both estimates are from the U. S. Census Bureau, but are produced using different methodologies and cannot be compared to one another. Child poverty rates at the State and county level are available once every ten years from the de-cennial census; estimates at the county level are available from SAIPE for 1989, 1993, 1995, and each year from 1997 to 2000. Considerations The official federal poverty level reflects an austere level of existence; the 2004 poverty guideline for a family of 4 was $ 18,850. Available research suggests that children whose families are “ near poor” also suffer significant disadvantages, com-pared to children in families who are better off economically. Thus, some public programs also include those children in families who earn a certain percentage above the poverty line, such as 150 percent or 200 percent. Congress has directed the Census Bureau to re- evaluate how poverty rates are calculated. Current Population Survey ( CPS) - Percent of related children under age 18 in poverty 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Single Year 18.5 12.2 16.8 15.8 16.3 13.4 6.9 6.5 6.6 7.0 7.3 10.3 3- year Average 15.0 14.3 15.8 14.9 16.3 15.2 12.2 8.9 6.7 6.7 7.0 7.7 National 21.6 22.0 21.2 20.2 19.8 19.2 18.3 16.3 15.6 15.8 16.3 17.2 Small Area Income and Poverty Estimates ( SAIPE) - Percent of people under age 18 living in poverty 1989 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Maryland 14.3 15.1 NA 13.2 14.1 14.9 12.6 10.1 10.7 9.4 10.1 NA National 19.6 22.7 NA 20.8 20.5 19.9 18.9 17.1 16.2 16.3 16.7 NA Maryland’s Results for Child Well- Being 2005 67 Related Measures Additional measures of children in poverty include enrollment data in means- tested programs such as the School Lunch or Food Stamps Programs. Related measures include single parenthood, low educational attainment, and part- time or no employ-ment. Discussion Although the economic downturn has moderated, there is a risk that the United States is again experiencing increases in child poverty similar to those that accom-panied the recessions of the early 1980s and 1990s. In 2003, there were 12.9 million children in poverty in the United States ( source: U. S. Census Bureau). Unemploy-ment has increased in Maryland during the last few years. Since reaching a low of 3.5% in 1999, the unemployment rate has climbed to a high of 4.7% in January 2004. The rate has declined and, in April 2005, stood at 4.1%. On an annual basis, Maryland has been below the U. S. average in unemployment during the same time period ( source: Maryland Department of Labor, Licensing and Regulation). For the past five years, the single year Current Population Survey ( CPS) estimate of child poverty rate for Maryland has been one of the lowest in the Union. It was the lowest in 2001 and second lowest in 2002, but is only the 6th lowest in 2003. Cau-tion must be used however, as the U. S. Bureau of the Census warns against the use of single year State level estimates for child poverty because of the survey sample size used. The SAIPE estimates on the other hand are considered reliable and valid as single year estimates— SAIPE also produces jurisdiction breakdowns whereas the CPS methodology does not. The 2001 SAIPE estimate for Maryland ( 9.4%) is the lowest ever, while the 2002 estimate for Maryland is the third lowest in the nation. Percent of Related Children Under Age 18 in Poverty ( based on CPS*), Maryland and National 1994 to 2003 5 10 15 20 25 30 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Percent Maryland, 3- year average National, single year estimate * CPS = Current Population Survey, U. S. Census Bureau Percent of Children Under Age 18 in Poverty ( based on SAIPE*), Maryland and National 1993 to 2002 5 10 15 20 25 30 1993 1995 1996 1997 1998 1999 2000 2001 2002 Percent Maryland National * SAIPE = Small Area Income and Poverty Estimates program, U. S. Census Bureau ( not available for 1994) Maryland’s Results for Child Well- Being 2005 68 SINGLE PARENT HOUSEHOLDS Indicator Definition The percent of all households that are headed by a single parent. The percentage of all families with “ own children” under age 18 living in the house-hold, who are headed by a person ( male or female) without a spouse present in the home. “ Own children” are never- married children under 18 who are related to the householder by birth, marriage, or adoption. The number of parents living with a child is linked to the amount and quality of human and economic resources available to that child. Generally, single parenting implies that there is no immediate adult back- up to reinforce disciplinary lessons or family teachings, to provide an additional role model, or simply to share the load of care. Children who live in a household with one parent are substantially more likely to have family incomes below the poverty level than are children who grow up in a household with two parents. Significance Baseline Data PERCENT OF ALL HOUSEHOLDS HEADED BY A SINGLE PARENT ( reported by calendar year). Data Sources 1991- 1999 Maryland data: three year averages based on special tabulations of Cur-rent Population Survey data prepared by the Bureau of Labor Statistics and pub-lished in the 2000 Kids Count Data Book: State Profiles of Child Well- being ( The Annie E. Casey Foundation). 1990- 1999 National data: Annual percentages from the US Bureau of the Census FM- 2: All parent/ child situations, by type, race, and Hispanic origin of householder or reference person: 1970 to present. 2000 Maryland and National Data: From 2000 Census, US Bureau of the Census. 2001 Maryland data from 2004 Kids Count Data Book: State Profiles of Child Well- being ( The Annie E. Casey Foundation). 2001 National Data: From 2001 Census, US Bureau of the Census. Considerations Jurisdictional breakdowns are not available. 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Maryland 28 27 27 26 26 27 27 28 27 29 National 25 26 26 26 27 28 27 28 24 28 Mother only 22 22 22 22 22 23 22 23 18 23 Father only 3 4 4 4 5 5 5 5 6 5 Related Measures Current Population Survey ( CPS) data from the U. S. Bureau of the Census provide national figures annually for family structure and the percentage of children under age 18 by presence of parents in household. Two parent, mother only, father only, and no parent ( e. g., children live with relatives or are placed in out- of- home care) breakdowns are available. State and jurisdiction breakdowns are not available. Maryland’s Results for Child Well- Being 2005 69 Discussion Perhaps the most controversial indicator that Maryland has chosen, single parenting, cuts across many social and economic issues facing the nation and Maryland, in-cluding concerns about rising divorce rates, increasing numbers of unwed births, child poverty, and juvenile delinquency. The significance of this indicator is that the number of parents living with a child is generally linked to the amount and quality of human and economic resources available to that child. Children of single parents are at greater risk to be in poverty. Nationally in 2003, 35.5% of children who live in single parent households with their mothers were below the poverty line. Regardless of race and social class, the youth of single par-ents are also at greater risk to become delinquents. Children of divorced and never-married parents are at greater risk to repeat a grade in school and to be expelled/ suspended, drop out of school, and/ or become teen parents. Drug involvement is greater among adolescents of divorced parents. While being raised by a single parent does not mean that children and youth will face such problems, the fact remains that increasing numbers of children are grow-ing up in single parent households. In 2003, over 82,400 Maryland children lived in single placement households. Maryland ranks 29th in the nation for the most fami-lies with children headed by a single parent. Maryland has focused on different aspects of the single parenthood challenge. Teen births usually result in single parent families and the State is engaged in a number of strategies to reduce teen pregnancy. Welfare reform efforts are underway in Mary-land which some may argue will address the problems of welfare dependency and illegitimacy. Also, Maryland’s Department of Human Resources has focused efforts on supporting single parents and promoting responsible fatherhood. More remains to be done in a climate of charged political tension over the best courses of action for public policy. Percent of all Households that are Headed by a Single Parent Maryland and National 1992 to 2001 5 10 15 20 25 30 35 40 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Percent Maryland National Maryland’s Results for Child Well- Being 2005 70 OUT- OF- HOME PLACEMENTS Indicator Definition Rate of children placed in out- of- home care. Rate per 1,000 children placed in foster care, juvenile justice, mental health, sub-stance abuse treatment, and education out- of- home placements. Children need safe and stable homes in order to thrive. Family instability, abuse/ neglect, extreme poverty, crime, violence, homelessness, substance abuse, and seri-ous illness/ disability may pose substantial risks to children and may contribute to the need for children to be placed in alternative care. Significance Baseline Data RATE OF ENTRY INTO OUT- OF- HOME PLACEMENTS - Per 1,000 chil-dren under age 18 ( reported by State fiscal year). Data Sources The Report on Out- of- Home Placements ( January 2005) tracks out- of- home place-ments by the Department of Human Resources ( DHR), Department of Health and Mental Hygiene ( DHMH) Mental Hygiene Administration ( MHA), DHMH Alco-hol and Drug Abuse Administration ( ADAA), DHMH Developmental Disabilities Administration ( DDA), Maryland State Department of Education ( MSDE), and the Department of Juvenile Services ( DJS). Data are not unduplicated and are also available by both agency and jurisdiction. Considerations These data are the combined total of out- of- home placements ( across agencies rather than for separate agencies). Jurisdictions with small numbers may want to use multi- year averaging. Related Measures DHR/ SSA tracks placements in Foster Care Family Care, Kinship Care, Pre- Adoption Services, and Treatment Foster Care. Additionally, the decennial Census measures the number of children who live away from their families in group quar-ters. These data include the child welfare, corrections, and mental health systems. Data from both sources are available by jurisdiction. Discussion Over the last decade the number of children served in out- of- home placements statewide has been rising steadily at an average annual increase of 0.5%. The num-ber served, however, has declined for a third year in a row, by 9.4%, from FY01 to FY04. In FY04, 26,226 children were served in placements, compared with 28,840 served in FY01. Only the following placement types experienced increases in num- 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Maryland 9.9 10.9 11.6 12.2 11.3 11.4 10.4 10.7 10.3 9.5 COSTS OF OUT- OF- HOME PLACEMENT ( MILLIONS OF DOLLARS - Actual Costs) 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Maryland 369.0 374.1 392.4 412.5 459.6 497.3 515.8 552.7 576.0 621.8 Maryland’s Results for Child Well- Being 2005 71 ber served from FY03 to FY04: MHA Institutional Placements ( 4.1%), ADAA Long- Term Care Placements ( 19.3%), and DHR Foster Care Placements ( 3.4%). Although the overall number of children served has decreased, the annual cost of out- of- home placements in Maryland remains high. The FY04 cost continues to exceed one half billion dollars and now stands at $ 621.8 million; the average annual increase per year is 5.9%. The rate of increase from FY03 to FY04 ( 8%) is higher than the average annual increase. Agencies report that the bulk of cost increases in recent years can be attributed primarily to increases in Medical Assistance payments for children in out- of- home care, an increase in the proportion of foster group care placements for DHR, and higher DJS costs. Rate of Children Age 18 and Under Placed in Out- of- Home Care* in Maryland State Fiscal Years 1995 to 2004 2 4 6 8 10 12 14 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Rate per 1,000 * This information includes data from DJS, DHR, DHMH ( MHA, DDA, ADAA), and MSDE. DHR FY 1995- 2004 includes Kinship Care. Costs of Out- of- Home Placement in Maryland 369 413 460 497 516 553 576 622 374 392 100 200 300 400 500 600 700 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Fiscal Year Costs ( in Millions of Dollars) Maryland’s Results for Child Well- Being 2005 72 PERMANENT PLACEMENTS Indicator Definition Percent of children who leave foster care for a more permanent status ( return home, known as reunification; or adoption) within a specified period of time in foster care. Reunification: Percent of children who return home within 12 months of foster care placement ( including kinship care). Adoption: Percent of children who are adopted within 24 months of foster care placement ( including kinship care). Children need stable care- giving. Research has shown that temporary foster care placements, often involving a number of different caregivers and settings, can be detrimental to children’s healthy development. Significance Baseline Data PERMANENT PLACEMENTS - Reunification within 12 months; Adoption within 24 months ( reported by state fiscal year - Maryland), and federal fiscal year - National). Reunification 2002 2003 2004 Maryland 58.2 50.0 55.0 National Average NA NA NA Federal Target 76.2 76.2 76.2 2001 NA NA 76.2 2000 NA NA 76.2 Data Sources The Social Services Administration ( SSA) Foster Care and Adoption Child Track-ing System ( FACTS) is used to track data on permanent placement status. Considerations Changes in policy and agency capacity can affect these data. An emphasis on keep-ing families together may be reflected in a lower rate of children entering foster care. Jurisdictions with small numbers may want to use multi- year averaging. Related Measures DHR/ SSA tracks the number of youth placements in Foster Care Family Care, Kin-ship Care, Pre- Adoption Services, and Treatment Foster Care. The Governor’s Of-fice for Children ( GOC) tracks youth in out- of- home care placed or funded by DHR, DHMH, MSDE and DJS. The decennial census counts children who live away from their families in group quarters, in the child welfare system, correctional institutions, and mental health facilities. Discussion The number of Maryland children who are reunified with their families within 12 months of placement in out- of- home care has fluctuated over the past three years, from 58.2% in FY2002 to 55% in FY2004. Since 1980, states have been required to demonstrate “ reasonable efforts” to provide assistance and services to preserve and reunify families; since the 1997 passage of the federal Adoption and Safe Fami-lies Act ( ASFA), the emphasis has shifted to time- limited reunification efforts. Adoption 2002 2003 2004 Maryland 26.8 25.8 20.1 National Average NA NA NA Federal Target 32.0 32.0 32.0 2001 33.1 22.3 32.0 2000 28.5 20.0 32.0 Maryland’s Results for Child Well- Being 2005 73 Likewise, ASFA has tightened requirements for states to apply for Termination of Parental Rights ( TPR) and seek adoption for a child. Frequently, a Local Depart-ment of Social Services may be working to secure an adoptive family for a child, even before the TPR is official, due to the sometimes lengthy timeframe needed to achieve TPR. Indeed, foster care staff are generally required to focus on two per-manency plans ( known as concurrency planning) to ensure that children remain in foster care no longer than necessary to promote their safety and well- being. Despite the decrease in the percent of children who were adopted within 24 months of entry into out- of- home care, the State of Maryland has been working aggres-sively to increase the number of children who are adopted or placed for adoption. In 2003, Maryland was one of 26 states to receive an “ adoption incentive” for having more children who were adopted from out- of- home care in 20 |
