Ruane Leads Effort to Invest in Neediest Children and Families of Orange County

Your website says, "we do not just fund projects with worthy goals. We fund worthy programs with results." What are those results?

Results include ensuring that children have access to a medical care, which for very young children usually means access to a pediatrician, a nurse, or family practitioner so they can get the preventative care they need to treat and prevent health conditions rather than treat them after the fact.

The First 5 Commission was a product of the Prop 10 tobacco tax, which allocated the money through each county and allowed for innovation to grow from those county programs. As chair of the state association of First 5 commissions, what's distinctive about the Orange County First 5 initiatives?

I'm currently president of the First 5 Association of California, which is the statewide association of all county commissions. Each commission is required to adopt a strategic plan but carries out unique programs that address community needs rather than a statewide cookie-cutter approach. In Orange County our unique initiatives have tried to bridge the educational and health sectors through the funding of specific positions. The most clear example was an initiative to fund nurses in every public school district in the county.

How do other commissions pick up ideas?

There's a strong commitment to results, which is almost unprecedented, in the Prop 10 initiatives. It says we should make funding decisions based on what's working and having the greatest impact. That emphasis on results and outcomes means that we share emerging best practices statewide. Many of the emerging best practices are programs that have become much more multidisciplinary. They might involve elements that were traditionally done through social work or public health or educational institutions and physically integrating them, much like the model New School Better Neighborhoods uses for joint use and collaborative programs. Or we're taking what we know from science and applying it to what we do.

Priorities are embedded in your First 5 commission and others focusing on the health and education of children ages 0-5. Each of those areas requires a lot of resources. What are you learning about how to leverage resources to address the holistic challenges that children and their families face in Orange County?

We've learned, and are continuing to learn, that funds can become available to address the needs of children and families both in poverty and community-wide, but that you often need a catalyst or convener to pull together very disparate funding streams and organizations that may not be used to working together. With modest resources you can create programs from existing dollars that have been in silos in the past.

NSBN and First 5/LA have been working on the notion that the school might serve as the platform for a seamless system of resources from preschool to kindergarten, from child care to public health and parenting programs. You've been experimenting with Project Connections family resource centers. Elaborate on the potential of that initiative.

I think a lot of our community investments utilize schools as the center of collaboration and community programming; many of our school readiness programs are at school district sites and involve joint use and collaborative use of facilities. Schools are widely recognized as a community asset that can host and support a variety of programs. More importantly, the elementary schools are trusted and identifiable places to offer other programming. We use them for health access, preventative programs, immunizations, family support, and other programs.

Our experience has been very much reinforced by our projects in Huntington Beach known as the Oakview Community, where they're looking not just at educational performance but also adding health programs and, in the future, economic sustainability to their community efforts. In the past because of overcrowding of schools, it's been difficult to look at facility opportunities, but now, as NSBN has done, there's been an effort in Orange County, through school bonds, to increase and expand facilities. Also, the level of overcrowding at some of the schools has decreased, and that has freed up some space for additional programming, particularly in Santa Ana and some of the other urbanized districts.

What has Orange County's First 5 commission done to take advantage of those available school spaces?

We will fund programs, staffing, as well as activities and events to use those facilities and also, where needed, to support expansion. We have a lot of modular facilities, and we can adapt portables for our programs when they're no longer needed.

With the failure of Prop 82, what should the agencies like your commission do to meet the needs of preschool children?

Locally, we will be focusing on an integrated and comprehensive approach to school readiness. There are five objectives that we can carry out in the community rather than focusing on one specific program. We believe, for example, every child should have access to dental screenings for preventative treatment. Second, children should not only have access to insurance but also to quality medical care in their community. It's very important that we have access to early literacy and language development programs in the community either at school sites or in community programs.

Families who are at-risk must be able to access and use family support services to help lessen and prevent impacts of family crises. And, finally, every community where we have under-served or overcrowded populations must have school readiness programs as one-stop resource centers for families to help improve the educational outcomes for their children.

Many commentators in reviewing the demise of Prop 82 believe that there was a lot of common ground and support for preschool but perhaps not for universality the way it was proposed. Can you comment on that assessment and where you'd like to see the next campaign go?

I can't really speculate on where future campaigns will go. However, despite the opposition to universal approaches to preschool, there was a lot of consensus that preschool should be expanded for those families who cannot afford it or who are at risk. Those include families that are homeless-in Orange County that might mean families that are living in motels and are transient-and the consensus was that those families should receive priority. We believe the governor and Legislature's action to put $100 million towards expansion of preschool for those most in need is a step in that direction. It's the type of program that I think can get community support. And half those resources in the budget were for facilities.

Several conferences this summer have focused on the built environment and health, including one at the California Endowment called, ‘Unhealthy by Design?' at which California Endowment CEO Bob Ross said, "You can have the best insurance and the best doctors in the world, but if you live in a poor-quality neighborhood, if you smoke or drink, if you're not getting exercise or five servings of fresh fruits and vegetables, you're doing yourself no good. How do we shift to a more holistic, community-based construct? It's hard for us, but we're trying to do that." Is healthy placemaking a theme O.C. First 5 is also exploring?

I think Bob Ross's statement is accurate. We think it also requires taking health to the home and to the community. In addition to establishing centers for improving the health and well-being of the community, we also fund a lot of public health home visitations. Those are both nursing positions as well as promatoras; we still fund programs that make house calls.

That's a critical part of our community engagement strategy-not just to have programs at schools and community clinics but also to reach out and fund people who go into the community and homes to help reach those folks. As Bob has said, it's not just about health coverage. It's about creating healthy environments and access.

Are Dr. Ross's views on the links between lifestyle choices and community health an appropriate policy priority?

They are. His views support the idea that we need to add and improve facilities to address the preschool needs of our children.

Orange County First 5 also helped underwrite an international conference on early childhood systems with the UCLA Center for Healthier Children, Families, and Communities. What was the value of that conference, and what did you take from it for your commission?

We have a partnership with the UCLA center. They serve as the strategic advisor and reviewer for all of our investments in pediatric health, both in specialty care and primary care. We felt it was important to have that outside review of the investments we're making as we try to improve the quality of pediatric practice in Orange County. The conference provided an opportunity to look at breakthroughs in the assessment and early prevention of developmental delays and disorders in young children and to look at what is being done in not only the United States but also Canada, Australia, and England.

We learned that many of the challenges faced in California are also faced in other countries and other parts of the United States. Also, it validated that we were on the right path to not just develop the best medical model for prevention and treatment but also to engage strong and meaningful community collaboration to really get ahead of these issues, much in the way that we have done with our community health interventions at schools. It's not simply issues that can be solved by funding positions. We also have to have a very strong effort to both engage and reach out to the community, parents, and caregivers.

In a recent NSBN publication Dr. Neal Kaufman referred to Dr. Lester Breslow's notion of health as a resource for living and talked about the challenge in California of lifestyle diseases "colliding with genetics in a toxic environment that can be improved only by modifying lifestyles, by healthy place-making, and by quality medical care." Is that the kind of medical model that you're exploring in Orange County?

Yes. I think the only thing I would add to that statement is that we have to carry out those initiatives in a way where there's a sense of ownership in the community. By that I mean not simply through outreach and marketing but assessing any of the apprehension or barriers that a community, caregivers, or parents might have in participating in these community health improvement efforts and building that into the program. It may be as simple as, for example, using a school or an educational facility as the focus of a campaign rather than using a medical facility, because of the support and proximity. It also may be that it's important for pediatricians to actually get out in the community rather than have everyone come to the clinic or their office.

What are some examples of things that the Orange County Commission has engaged in to model this kind of resource center?

The best example is that we are sponsoring a demonstration project in the Newport-Mesa School District that is geared at assessing and identifying developmental delays and other conditions that impact learning through an entirely community-based model. The school district and the community are joint partners in carrying out what is an effort to screen all children at a very early age so that they can get help and resources and support before they enter elementary school. While we know what the right thing to do is in terms of the science, it's often very difficult to engage young children and families before they enter school because there's no mechanism to reach those children.

First 5/LA has funded NSBN to work in East Hollywood with the community charter school and the L.A. Free Clinic to try to do the same thing, and they've run into challenges of how to provide those screenings on the campus rather than the clinic. Have you had success in satellite centers doing these screenings?

Yes, although I think part of what has been enhanced is when you also make the investment in the human infrastructure of school nursing. And we also fund coordinators in every district who help develop programs. We've built upon those investments we made several years ago, so when we add programs we already have resource people in the field who can bridge those silos. Sometimes the best bridge between the health and medical community and the educational community may be an experienced school nurse.

How can you justify being trained as an urban planner and be running First 5 Orange County? Is there a link between your training and your work today?

I still serve as project director of the Orange County Community Indicators Report, which is a comprehensive assessment of the social, economic, and environmental conditions in the community that are tracked over time.

Because the children and families are also a product of the environment they're in, the background I have in both large-scale planning and economic development are very helpful to my job. Second, the training we had as planners at UCLA-and I still teach in the graduate program at UC-Irvine-a lot of our training was in applied community problem-solving, and we were to add knowledge to action. With that type of background, the mission of First 5 is really applied strategic planning and taking a lot of the principles and skills from planning and applying them to the emerging area of community health and school readiness.

Would it be fair to say that the silos are as real in academia as they are in public entities in that the health professions and child social service graduate schools have little relationship to community planning and economic development and that we need to close that gap?

Silos do exist in academic institutions. Generally, the community and the professional community has given the input to the academic institutions of the need for greater collaboration between silos. The best example is the fact that people are trained to get an MBA in a graduate school of management and they might get an architecture or planning degree at a school of design or urban planning school, yet in the professional world they're working side-by-side on the feasibility and implementation of projects. And the same is true with a nonprofit housing development.

I think it's incumbent upon the professional community and the organizations to feed back to the academic institutions and promote greater cross-disciplinary work or joint courses and programs that promote much more applied community problem-solving to the challenges facing California and our nation. I think the traditional academic model of joint degrees is not sufficient to deal with the interdisciplinary nature of what programs like NSBN or what we do at the local level encounter.