California Health Report | HealthyCal - Part 10
 

California Health Report

  

In the schools, creativity and accountability can co-exist

By Daniel Weintraub

Arguing that Sacramento is micro-managing the public schools, Gov. Jerry Brown is pushing hard to give local districts and individual schools more power over spending and classroom instruction.

Brown tried a similar approach last year but fell short as he and the Legislature were overwhelmed by the state’s budget crisis. But now that the budget appears to be on firmer ground, the governor is turning again to education policy, pledging to modernize what he sees as a system stuck in the last century.

Californians should watch carefully. Decentralization of the school finance system is long overdue, and tweaking it to address students’ needs, not just numbers, would be a good thing. Repealing specific programs mandated by the state would also be smart. But if the governor also seeks to reduce the state’s role in holding schools accountable for what they teach, he could hurt the very kids he says he is trying to help.

In his state-of-the-state speech Jan. 24, Brown, in his unique style, offered this colorful description of the status quo:

“The laws that are in fashion demand tightly constrained curricula and reams of accountability data. All the better if it requires quiz-bits of information, regurgitated at regular intervals and stored in vast computers. Performance metrics, of course, are invoked like talismans. Distant authorities crack the whip, demanding quantitative measures and a stark, single number to encapsulate the precise achievement level of every child.

“We seem to think that education is a thing—like a vaccine—that can be designed from afar and simply injected into our children. But as the Irish poet, William Butler Yeats said, ‘Education is not the filling of a pail but the lighting of a fire.’”

The first leg of Brown’s reform agenda focuses on school finance. Instead of giving every school essentially the same amount per student regardless of need, Brown proposes to give more money to schools that teach more children whose first language is not English or who come from poor families.

Common sense says it is tougher to teach kids who do not speak English. Schools have to teach them the language and the regular curriculum at the same time. And poor children usually don’t have the same support at home – computers, extra materials, tutors and well-educated parents – as students from middle class and wealthy families. Brown wants to close that gap.

But the governor is a good politician, so he knows he would never succeed by taking what some schools have now and giving it to others. Instead, he wants to fund the needs-based grants he envisions going forward, out of new money. Schools serving middle-class kids would get less new money than they would under today’s rules, and schools with a lot of poor and immigrant children would get more of the growth in revenues.

Brown is also proposing to cut many of the strings that Sacramento has tied to the money it sends to the schools.

This is a worthy goal, as lawmakers have a way of seeing the need for a law in every anecdote. A school shooting means requiring every campus to have a security plan. Outdated textbooks in one district lead to a separate pot of money that can be spent only on school materials. A district that lets its buildings deteriorate impels the Legislature to require set-asides for maintenance, and deferred maintenance. And so on.

While it’s a myth that most of the schools’ money gets wasted on administration, it is true that far too much of it is tied up serving the myriad priorities of generations of legislators, most of them long gone from office and many of them dead. Brown wants to wipe the slate clean (or nearly clean) and start over, with the presumption that local communities and the school boards they elect know best how to spend their money.

Brown calls this the concept of “subsidiarity” – the idea that a central authority should do only those things that cannot be done at the local level. The state, he says, should respect the jurisdiction of local school districts and “the dignity and freedom of teachers and students.”

But then he takes a leap. In his speech, Brown said he saw this concept extending to “what is taught, how it is taught, and how it is to be measured.” He added: “I would prefer to trust our teachers who are in the classroom each day, doing the real work – lighting fires in young minds.”

That’s a good impulse. Teachers and their immediate supervisors should decide how they teach. But deciding what they teach – what we, as a state, want young people to learn – is different. That’s the job not just of teachers but the people who hire them, either the community, the district or, if we want consistency across California, the state.

Otherwise, we risk returning to the days before California adopted academic standards in the 1990s, when every teacher decided for himself or herself what concepts of history to teach, what algebra was, and whether teaching chemistry should include the periodic table of elements.

The result was a lot of creativity, and very little accountability. Parents had no way of knowing whether their children were learning the concepts they needed to get into college, get a job or participate in civil society. And the children who suffered most were the poor, immigrant kids Brown says he’s focused on. Their schools generally had low expectations for them, and a lot of them fell through the cracks.

Since the adoption of academic standards, minority and poor children are mastering basic skills in far greater numbers, and far more of them are going on to college and graduating. Some teachers complained about having to “teach to the tests,” but many welcomed the clarity that came with specific benchmarks, and students were the winners. The performance gap between rich and poor, white and minority students has narrowed, even if it has not closed completely.

So Brown is mostly on the right track. The school finance system needs an overhaul, and the state should recognize that it costs more to teach a poor child or one with language limitations. Sacramento should get out of the way and let school districts, principals and teachers decide how to spend the money.

Finally, we should treat our teachers like other professionals. If you go to a doctor, you tell her what ails you and you tell her when you feel better. If you hire a lawyer, you tell him what problem you need him to solve. If you go to an architect, you tell him what kind of building you need. And then it is the job of these professionals to take your requests and use their training and best judgment to satisfy your needs.

Teaching is no different. It’s up to the people of California to decide what we want our children to learn in school. And then Sacramento politicians should get out of the way and let the schools and the teachers to decide the best way to teach that material.

Daniel Weintraub has covered public policy in California for 25 years. He is editor of the California Health Report at www.healthycal.org

 

Lessons learned housing homeless during freeze

By Marty Graham
California Health Report

When San Diego Police Department Assistant Chief Boyd Long found out San Diego, where an estimated 9,800 homeless people live, had four days of record cold weather coming, he knew he’d have to scramble to save lives.

“I’ve been watching these poor souls lay their heads on concrete for 28 years,” said Long, who is retiring this month. “This is really an under-served and poorly served population – and we (the police) are the frontline providers. We mobilized to make sure no one died in the cold.”

That was a valid concern, it turned out. In Costa Mesa, 80 miles north of San Diego, two homeless people died from exposure in separate locations the third night of freezing weather.

“We couldn’t get the word out fast enough,” says Bob McElroy, who works every day for the Alpha Project. “The folks on the street are so locked into survival mode that they don’t think to look for anyone interested in keeping them alive. We had people who had ice on their clothes, it was that ragged.”

Once Long heard the predictions for freezing temperatures from Jan. 11 to Jan. 15, he started pounding on the doors of established shelters –most filled to capacity with waiting lists, and started to push for floor space. Armed with funding from the San Diego Housing Commission and the credibility the HOT team had established, he was able to rustle up space for 600 indoor nights of sleep.

Because of a special designation by HUD, the housing commission was able to fund the emergency sleeping arrangements, which cost about $15 per person per night.

People who didn’t usually sleep in shelters or who were wait-listed showed up at the St. Vincent de Paul dining room, the Neil Good Day Center, Rachel’s Women’s Center, the Rescue Mission.

The lessons to be learned are pretty simple, Long said. “We need to start breaking the silos down so people aren’t shuffling around trying to understand a bunch of conflicting rules and structures,” he said. “You should not have the Rescue Mission working independent of the Salvation Army independent of St. Vincent de Paul. There’s a lot of administrative redundancy and a lot of confusion for the homeless.”

 

Feds propose new health rules for school snacks

The USDA has proposed new regulations to make school snacks healthier. The rules would affect snacks sold in vending machines, cafeterias and school stories but exempt treats brought into the classroom by students and parents (including birthday cupcakes) and food sold at after-school events like football games. To see the rules, click here.

 

California’s rate of premature births declines slightly

California’s rate of premature births declined a tick in preliminary data from 2011, but is still higher than the March of Dimes goal of 9.6 percent by 2020, the group said in a national report card issued this week.

California earned a “B” grade in the report as its rate declined from 9.9 percent to 9.8 percent in 2011.

California’s rate was bettered only by Oregon, New Hampshire, Vermont and Maine, according to the March of Dimes.

See the group’s full report here.

 

Is the ACA the road to semi-single payer?

The Wall Street Journal has an interesting, and important, story on how some unions that supported the Affordable Care Act are now wary about how it will affect them once it is fully implemented. At issue is whether workers who get their health care through unions will be eligible for the same subsidies that are available for lower-income people who will get their insurance through the new health exchanges, or Covered California here.

As the law was envisioned, union workers would not be eligible for subsidies, just as others who get their coverage through work are ineligible. The idea is to use scarce dollars to help make insurance more affordable for those people who can’t get it anywhere else.

But the unions are worried because employers with fewer than 50 workers will not be required to provide insurance for their employees. Those workers will instead buy their insurance through the exchanges, and most will probably qualify for subsidies, which will vary depending on family income.

This — combined with the realization that, at least in the short term, premiums will be going up for most working-age people — threatens to create a situation in which the unions, by providing coverage for their workers, will price those workers out of the market. Small, non-union contractors who don’t have to provide insurance will be able to underbid the unionized companies.

The unions see this as a threat to their existence. But it also raises what I think will turn out to be the most important question about health reform: what will employers do?

Last year several restaurant owners made news, and invited public backlash, by admitted that they were cutting back their workers’ hours so that they would qualify as part-timers and thus not trigger the mandate for employers to provide coverage. Earlier this month Chicago mayor and former Obama chief of staff Rahm Emanuel said the city might stop providing retiree health care and instead send its former workers to the state-run and federally subsidized health exchange.

Now even the unions are talking about dropping insurance and sending their workers to the exchanges. If these musings become real and turn into a stampede, will the exchanges be able to handle the load? And will this lead, eventually, to the exchanges becoming de-facto single player plans, with most people getting their coverage through them?

I’m not sure whether that would be a good thing or a bad thing. Our employer-based system, after all, is responsible for many of the ills we now face in the world of health care. But it might have made more sense to design the system with this outcome in mind all along (as Bill Clinton’s much maligned reform plan would have largely done). On the other hand, any overhaul of the current system would have faced bumps and changes along the way. So maybe it is just as well that we sort of stumble and bumble our way to a new consensus about a health insurance system that might soon look radically different from the one we have today.

–Daniel Weintraub

 

Poll: 55 percent support health reform in California

By Daniel Weintraub
California Health Report

A record-high number of Californians now support the Affordable Care Act — President Barack Obama’s federal health reform plan, according to a new independent poll.

The survey, by the Public Policy Institute of California, also found the highest support ever for a plan to allow undocumented immigrants to become legal U.S. residents.

The poll questioned ,704 California adult residents between Jan. 15 and Jan. 22. The margin of error was plus or minus 3.5 percentage points.

On health reform, 55 percent of Californians now support Obama’s plan, which will take full effect in January, 2014. That’s up from 47 percent last March. Thirty-seven percent say they oppose the plan, which will require nearly every American to have health insurance, with subsidies for those who can’t afford it on their own and new regulations controlling the way insurers deal with their customers.

Still, support for the plan breaks down largely along party lines. Among Democrats, 76 support the program while among Republicans, 78 percent oppose it. Independents are split, with 44 percent in favor and 47 percent against.

About half of Californians say they don’t think the plan will affect them personally, with about 25 percent saying it will make their situation better and 23 percent saying it will make them worse off.

On immigration, a record-high 76 percent of Californians say they think undocumented immigrants should be able to keep their jobs and eventually apply for legal status.

While Democrats take this position more often than Republicans and non-partisans, even 59 percent of Republicans favor a plan to allow undocumented immigrants to obtain legal status.

A record-high 63 percent of Californians view immigrants as a benefit to the state, while 31 percent say they are a burden.

To see the entire poll, go here.

 

Report on re-arrest rates highlights potential and shortfalls of prison reform

By Heather Tirado Gilligan
California Health Report

People on parole or probation do not account for most new arrests in four cities in California, according to a new report. Instead, it is people who are not on supervision who are arrested most frequently.

“Most people would have stated before this report came out that probationers and parolees were the primary source of crime in their communities,” said Terri McDonald, undersecretary of operations for the California Department of Corrections and Rehabilitation. “At least in these four cities, this does not seem to be the case.”

The report showed that people on parole or probation commit only one in six violent crimes and one in five crimes overall. In comparison, more people on supervision committed drug crimes, but they were still not close to a majority of the offenders. In that category, people on probation or parole account for one in three arrests.

The report analyzed arrests between and 2008 and 2011 in Los Angeles, Sacramento, San Francisco and Redlands. It was produced by the Council of State Government’s Justice Center, a national, non-profit, non-partisan research group, at the request of the police chiefs of each city.

Though the report did not examine a representative cross-section of California, it captures what is going on in three major metropolitan areas where a significant chunk of the state’s population lives, said Robert Coombs, communications director for the Council of State Governments.

The report’s analysis covers the period just before prison realignment, or AB 109, began in October 2011. But it does highlight some of the potential that reform has to prevent people on supervision from committing new crimes, as well as ways that reform may be falling short in effective crime prevention.

“The question is one of how to best prioritize resources,” Coombs said. “Who do you provide services and programs for?” Asking where services can be cut is another important part of prioritizing scare resources, he added.

The higher number of drug-related crimes among people on supervision, for instance, indicates a need for more rehabilitative services.

Limited resources could also be used more effectively with better risk assessments, especially as the number of people on probation grows, to help decide which people need the most supervision. Risk assessments use a series of questions about criminal history, attitudes, personality and life circumstances to determine whether or not someone is likely to commit another crime.

“It’s really important that we implement a system of triage,” said Wendy Still, San Francisco’s probation chief. “The success of realignment depends on the ability of probation departments to supervise a larger number of people successfully.”

Since prison reform began, people who commit certain non-serious felonies receive jail time or split sentencing, a combination of county jail and probation, instead of state prison and parole. People who were sentenced to prison for one of these crimes before reforms began are also released to the supervision of county probation agents, rather than state parole agents.

But while the state’s parole division generally did a good job of using risk assessments to determine who was likely to commit another crime, and allocating resources accordingly, only one probation department in the study – San Francisco – used a risk assessment that was good at predicting who would reoffend.

These assessments determine how much contact people under supervision have with their probation or parole officer.

Aiming more resources at people more likely to commit crimes and less at low-risk offenders offers a better return in terms of crime reduction, Coombs noted.

Changing policing and sentencing practices to encourage more supervision for people who have been assessed as high-risk and more rehabilitation overall may prove difficult, despite the encouragement provided by reform.

It may be hard, for instance, to shake the perception that all people on supervision are high-risk, focus groups with police officers suggested. In the focus groups, conducted as part of the report’s research, police officers described situations where they arrested the same people on probation or parole multiple times. Such experiences could contribute to the widespread misconception that people on supervision are the primary source of crime, the report said. Police in the focus group also held misconceptions about what determines risk level, and had difficulty accessing information about people on probation and parole beyond a name and address.

A recent analysis of split sentencing by the Chief Probation Officers of California also suggests that judges continue to sentence people to jail much more frequently than they use other options meant to encourage the rehabilitation necessary to prevent more crime.

Split sentencing, a combination of jail and probation, is a new option under the reform law. Split sentencing is meant to offer support as well as supervision to people leaving jail as they return to the community.

Only 5,000 felony offenders affected by AB 109 have received split sentences since realignment began, according to the analysis by the Chief Probation Officers of California, which was released in December. In contrast, more than 16,000 received straight jail time.

Straight jail time means no supervision – or support and rehabilitation – from probation after release from jail, which is a critical time of transition. “This is the period when recidivism is most likely,” the probation chiefs’ report notes, adding that “the research is clear – these offenders will have a higher likelihood of committing more crime than those who have been given a split sentence.”

Data from some counties for the first year of reform indicates that many people affected by realignment who reoffend or violate the terms of their probation are committing drug-related violations.

During the first ten months of realignment in Alameda County, for instance, drug crimes accounted for 22 percent of new crimes committed by people who were under the supervision of probation because of prison reform. The next most common reason for re-arrest among people on probation instead of parole because of reform – a type of probation that is called post-release community supervision – was auto theft. It followed distantly at 9 percent.

In Fresno County, between April and August of 2012, people on post-release community supervision were sanctioned most often for drug-related violations. And during the first year of realignment in San Francisco, drug crimes were the single largest category of new offense, accounting for 48 of the 126 new crimes committed by people on post-release community supervision.

The Council of State Government’s report emphasizes the importance of substance abuse treatment options, said McDonald of the CDCR. “You cannot use a jail bed for every problem that you have,” she said.

The report’s final recommendations included improved risk assessment, more rehabilitative options and improving data sharing between police departments and departments of probation and parole.

 

Special Needs Children Struggle to Obtain Quality Health Care

By Rosa Ramirez
California Health Report

California children with special needs often receive less-than-adequate health care services, regardless of whether they are covered by private or public health insurance, a new analysis has found.

California was among the bottom six states in offering coordinated and family-oriented care to some of the state’s most vulnerable populations.

According to the report, 1 in 10 California children, or about one million, have special health needs.

Some key findings:

–California families are more likely than those in other states to reduce their working hours or stop working altogether to manage their child’s health care needs.

–41 percent of children with health insurance don’t obtain the services to meet their health needs.

–More than 40 percent of youngsters with complex health needs have a difficult time obtaining community-based services, such as finding doctors and scheduling appointments.

The health care they receive as children greatly impacts their ability to thrive as they grow and move through school, said Christina Bethell, lead author of the report and director of the Child and Adolescent Health Measurement Initiative at Oregon Health and Science University. The study was sponsored by the Lucile Packard Foundation for Children’s Health. (The Foundation is also a sponsor of HealthyCal.org.)

Part of the challenge is that researchers have only started collecting national child health data since 2001. “Even children with the least complex health conditions, the majority are not receiving the basic quality of care,” said Bethell.

In addition, a nationwide dearth of pediatricians with sub-specializations, as well as health providers who are able to care for these children as they transition to adolescence, has become worrisome.

Most pediatricians spend an additional two-to-three years on sub-specialty training, often with little economic incentives, said Edward Schor, senior vice president at the Foundation. “It extends their life as a trainee and postpones getting out into the world and working,” Schor said.

The study found that inadequate health care services places added financial and emotional burden on parents. About a third of California families with at least one child with health care needs are forced to cut back on working to manage their children’s access to care. These caretakers often manage multiple health services, including school-related programs, doctor’s appointments, and medical emergencies, Bethell explained.

San Francisco resident Maria de Lourdes Sanchez, 38, takes her 10-year-old son, who was diagnosed with cerebral palsy as an infant, to physical, speech, and occupational therapy, which keeps her from holding a full-time job.

But even outings to the Sunday mass or attending family birthday party have become rare occasions, especially now that her son is taller and stronger. Carrying him inside the family’s van is difficult for her and her husband. She’s applying to obtain a free or low-cost wheelchair ramp to make trips to her son school, medical appointments, and therapies feasible.

Echoing earlier studies, the January report found that communities of color are less likely to report their child’s special health care needs. Bethell said it could be attributed to their desire to use alternative health methods, feeling overwhelmed about having to arrange doctor’s appointments due to a language barrier, or holding jobs that do not offer them the flexibility to take time off.

With limited English skills, Sanchez recalled feeling frightened when she sought help for her son when he was months old. “I’d take him to the doctor and say, “My son is not breathing,’’ she said in Spanish. “The strength and courage to speak up for your children just comes out naturally.”

She now encourages other Spanish-speaking parents to ask questions, call service providers a second or third time, and show up at their offices if necessary to get health and educational services for their children. “We have to fight for children,” she said. “Parents are the only ones who can help them get ahead in life.”

 
 
 

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