Human Services Strategic Plan
Wake County believes that, to be effective, we must provide Human Services that are:
- Community-based: Create partnerships with neighborhoods and communities to build the capacity of citizens to address their needs and improve their quality of life.
- Family-centered: Incorporate the family as the center of focus where possible, realizing that "family" has a broad definition and that all persons have natural support and/or "families of choice."
- Prevention-focused: Emphasize the importance of education and early intervention to avoid or reduce the effects of disease, poverty and lack of resources.
- Culturally competent: Acknowledge the importance and impact of cultural, linguistic, economic, ethnic and gender and age differences.
- Outcome-driven: Direct attention to the assessment of the agency according to the results it achieves and not the specific "products" or "units" it produces.
Individuals who have concerns about the services they have received may call the Consumer Rights Program at 919-212-7155.
Wake County Human Services has committed to the following outcomes. In order to measure progress toward these outcomes, indicators are being developed to show the progress we are making toward achieving our outcomes. While the number of indicators is small at this time, we are working to create a set of indicators that accurately reflect the work that Wake County Human Services staff do.
Please select an outcome below for more information:
Outcomes not hyperlinked are currently areas in which indicators are being developed.
Indicator: Infant Mortality Rate
Why indicator was selected: Infant mortality is a measure that is often used as an indicator of the health status of the community, since it measures not only the capacity of the health care system to provide care, but the support systems to help women with high-risk pregnancies get good prenatal care. Preventive services, such as smoking cessation classes, also improve the probability that the baby will be born healthy. Because the infant mortality rate is used by many agencies, the information is comparable with state and national data.
How indicator is measured: Infant death data come from the State Center for Health Statistics where death certificates are compiled annually. These rates represent the number of births and infant deaths that occur in a calendar year and do not match the birth cohort of a year's infant deaths. This rate is sometimes referred to as the raw infant mortality rate, as opposed to the matched infant death rate.
How Wake County is doing: Wake County has made steady improvement since systematic birth and death recording began in the early 1900s. In the 1980s and 1990s Wake has seen declines in both minority and white infant death rates, although the disparity between whites and minorities is still large. Wake County's rates mirror those of North Carolina and the United States, but are in general slightly less than the state and slightly higher than U.S. rates. Neither North Carolina nor Wake County met the U.S. Department of Health and Human Services' Healthy People 2000 goal of seven infant deaths per 1,000 births.
Infant Death Rates, NC and Wake County 1980-1998
Source: State Center for Health Statistics
Infant Deaths by Race, Wake County, 1980-1998
Source: State Center for Health Statistics
Indicator: Infant Health Index
Why indicator was selected: The Infant Health Index is a composite measure composed of four common pieces of information collected on the infant and his mother. Each piece adds to a total picture of the baby's physical condition at birth and the quality of the infant's prenatal care. It has long been recognized that good prenatal care leads to fewer complications of pregnancy and delivery. Infants who are born healthy are less likely to require extensive follow-up care. Each of the indicators that make up the Infant Health Index could stand alone, but using the four indicators together is a better way to measure the broad health of the infant.
How indicator is measured: One of these measures is the apgar score of the child. This scale measures the child's responsiveness to its environment (such as reflexes) and the baby's physical condition (such as breathing and heart rate). Two other components of the Infant Health Index are: the child is not premature in gestation or weighs too little. The last piece of the IHI is that the mother received adequate prenatal care. The IHI shows the percentage of births with all positive responses (High apgar score 9 or 10, gestation of 37 weeks or more, birth weight of greater than 5.5 pounds, and a mother beginning prenatal care in the first three months of pregnancy).
How Wake County is doing: The percentage of live births with positive birth conditions has remained steady over the past five years, with little fluctuation. Minorities fare considerably worse, with just more than half (55.8%) of births exhibiting all four positive birth conditions in 1997, as compared with three-quarters (74.2%) of white births.
Infant Health Index by Race, Wake County, 1993-1998
Source: State Center for Health Statistics
Indicator: Short Cycle Births
Why indicator was selected: In addition to supporting women who are pregnant, WCHS seeks to help families space deliveries so that their babies are healthy. Women who give birth within 12 months of a previous pregnancy are more likely to have problem pregnancies, miscarriages or infant deaths; therefore, the prenatal, family planning and well-child clinics at WCHS counsel women seen in their clinics to keep their birth-to-conception spacing at more than 12 months.
How indicator is measured: This indicator is the percentage of births whose mother's delivery history shows a previous birth within 12 months. The mother's previous delivery history is shown on the birth certificate. Birth data come from the State Center for Health Statistics, where certificates are compiled annually. These rates represent the number of births that occur in a calendar year to residents of Wake County.
How Wake County is doing: About a quarter of all births to Wake County mothers in 1998 were conceived within a year of a previous birth. The percentages for all women in the state were very similar to Wake County, perhaps indicating that this measure is not sensitive enough to change.
Percent of Resident Live Births (excluding first births) with Birth-to-Conception Interval of Less than One Year, 1993-1998
Source: State Center for Health Statistics
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Why this indicator was selected: The immunization rate is a window on communicable diseases in the future. Required immunizations are inexpensive and readily available and reflect the parent's utilization of the health care system. Childhood disease averted should result in fewer disease-related school absences and medical expenses. Because of this, the immunization rate is an important piece of the U.S. Department of Health and Human Services' Healthy People 2010 measures.
How indicator is measured: Immunization rates are collected by Wake County Human Services. For each child who lives in Wake County, information on each immunization is gathered and adequacy of immunization determined. The immunization rate is calculated as the number of children whose immunizations are current at the age of two divided by the number of children age two who are residents of Wake County.
How Wake County is doing: Wake County is proud to have achieved its Healthy People 2000 goal of 90% of 2-year-olds age-appropriately immunized. About a third of the counties in the state surpassed this goal, but Wake was the only large county to do so.
Percent of Two-Year-Olds Age-Appropriately Immunized and Healthy People Year 2000 Goal, 1995-1998
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Indicator: At or Above Grade Level
Why indicator was selected: Both Wake County Public Schools and Wake County Human Services committed to the goal that 95% of children in grades 3 and 8 would pass end-of-grade tests by the year 2002. End-of-grade testing also allows for a standardized assessment of how well children from various schools and geographic areas are performing.
How indicator is measured: The School Accountability System's End-of-Grade testing is the basis for the indicator. Rates of third- and eighth-graders performing at grade level in the Wake County Public School System is reported at the end of each school year.
How Wake County is doing: Test results for third- through eighth-grade students' EOG tests for 1998-99 were the highest ever achieved locally. More than 80 percent of Wake County students performed at or above grade level in reading in all grades tested. In math, the results were even higher for grades 4 through 8, where 84 percent of students scored at or above grade level Although third-grade scores improved, they did not quite reach the high level of grades 4-8.
In EOG reading the district has gained nearly 16 percentage points since 1994; in math, 12 percentage points.
Reading - Third-grade reading went from 79.3 in 1998 to 80.4 percent at or above grade level in 1999; and eighth-grade, 86.4 up to 87.1 percent.
Math - Third-grade math went from 75.4 in 1998 to 77.1 percent at or above grade level in 1999; and eighth-grade, 83.2 up to 83.8 percent.
In terms of reaching the goal of 95 percent of students at grade level, it's going to take a synergistic effort. Making the leap from 70 percent to 85 percent at grade level is a 15-point gain, but that's an easier 15 percentage points than from 80 percent to 95 percent.
Percent Performing at Grade Level in Reading and Math (3rd Grade)
Source: Wake County Public School System
Percent Performing at Grade Level in Reading and Math (8th grade)
Source: Wake County Public School System
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Indicator: Child Pregnancy Rates
Why indicator was selected: Research indicates that teenagers who become pregnant are far more likely to need social supports, such as WorkFirst. But aside from the need for support services, teens who become pregnant are more likely to drop out of school, to be underemployed, and to have other problems, such as drug or alcohol abuse. To break the cycle of poverty, we must prevent children from having children. Compared to older mothers, teens are more likely to have many children, to be a single parent, to rely on public assistance, and to have poor pregnancy outcomes, such as fetal deaths or low-weight births.
How indicator is measured: Pregnancies are made up of three components: live births, fetal deaths and abortions. Births and fetal deaths are reported to the State Center for Health Statistics by the hospital or midwife. Abortion data without identifying names or addresses are also required by law to be submitted to the State Center for Health Statistics. Births, abortions and fetal deaths are aggregated to create the number of pregnancies, which are available by age, race and a number of other variables. These data do not include miscarriages of less than 20 weeks gestation. Rates are calculated as the number of pregnancies to women under age 18 per 1,000 women in the ages category.
How Wake County is doing: Teen pregnancies in Wake County compared favorably with pregnancies among the rest of the state's teens. In 1998, the state rate was 21.3 pregnancies per 1,000 girls ages 10-17; Wake's rate was only 14.0. There is a large disparity in the rates of whites and minorities in both the state and Wake County, but minority rates have fallen 38% since 1993.
Child (10-17) Pregnancy Rates, Wake County
Source: State Center for Health Statistics
Indicator: Binge Drinking
Why indicator was selected: Substance abuse among teens is very common among Wake County teens. Alcohol is still the drug of choice among teens. In a 1998 survey of Wake County high school students 42 percent reported using alcohol at least once in the past year. More alarming than occasional use, however, is the abuse of alcohol to extreme excess, drinking more than five alcoholic drinks in one sitting. Teens who binge drink are likely to have accidents and exhibit poor judgment.
How indicator is measured: Every two years, Wake County Public Schools surveys students in ninth through 12th grades, asking them questions about crime, violence, drug use, alcohol and tobacco use, and other issues which may prevent students from applying themselves fully to their schooling. Binge drinking during the past 30 days is one of the at-risk behaviors that is (as of 1998) being reported. ("How many times have you had more than four glasses of alcohol in a row?")
How Wake County is doing: In 1998, 20% of Wake County High School students reported having had more than four glasses of alcohol in a row during the past 30 days. Nine percent reported that this had occurred three or more times. The incidence increased at each grade level. By the 12th grade, the incidence was reported at 29.9%. Wake County had not asked this question in previous surveys, but North Carolina students had been asked and have a slightly higher rate, which has remained around 23% since 1993.
Percentage of Students (North Carolina and Wake) Who had More than 4 Drinks of Alcohol in a Row in the Previous 30 Days
Source: Wake County Public School System
Indicator: One Year Use of Substance
Why indicator was selected: It is critical that Human Services and Public School staff understand the extent to which alcohol, tobacco and other drugs have invaded adolescent lives. The use of alcohol and drugs interferes with physical, emotional and intellectual development in early and mid-adolescence. Literature suggests that teens who use alcohol and marijuana are many times more likely to initiate the use of crack, hallucinogens and opiates. They are also more likely to engage in risky behaviors such as unsafe sex.
How indicator is measured: These data, as with the information on binge drinking, come from the Wake County Schools survey on student behaviors. Every two years students in ninth through 12th grades are surveyed about crime, violence, drug use, alcohol and tobacco use, and other issues that may prevent students from applying themselves fully to their schooling. The percentage of students who reported using any drug, alcohol or tobacco during the past year is reported.
How Wake County is doing: In 1998, the reported use of alcohol in Wake County high school students continued to decline over previous years (1994, 1996). The use of marijuana has remained the same, at around 23% of Wake County High School students, and tobacco has slightly increased, to above one in three. For alcohol, use increases with school grade (29% in ninth grade, 66% in 12th grade) and is most prevalent among white students, somewhat less among black, Hispanic and Asian students.
During the Past Year, Did You Use, Wake County Students, by Year
Source: Wake County Public School System
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Why indicator was selected: Supporting Wake County's families means encouraging families to be strong, loving and supportive to all their members. Domestic violence takes a heavy toll on the victims, but also results in higher foster care, public support and medical care costs. Children from strong, loving families are less likely to become involved in juvenile crime, drug use, or to become teen parents. Literature also suggests that child abuse and neglect begins a cycle, which follows throughout the life of the child, as a precursor to later difficulties.
How indicator is measured: Reports to Child Protective Services are used to determine the prevalence of child abuse and neglect in the county. The number of substantiated reports of abuse and neglect, divided by the estimated child population, determines the rate of abuse and neglect (reported per 1,000 children).
How Wake County is doing: Wake County's child abuse and neglect rate hit a low of 6.4 substantiated cases per 1,000 children in fiscal year 1997. It rose slightly to a rate of 8.2 in FY 1999. In FY99 Wake County Human Services received almost 4,700 reports of child abuse and neglect, for which 1,231 cases were substantiated – about one-quarter of reports.
Rate of Child Abuse and Neglect, Wake County, Fiscal Years 1995-1999
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Why indicator was selected: One way to determine how well parents support their children medically is to look at their oral health. Children who are decay-free are those with no caries because of good dental practices, access to preventive care, or because the teeth have been repaired. In either case, parents were involved in making dental care available to their child.
How indicator is measured: Each year, hygienists from WCHS go out to schools in Wake County to screen children's teeth. Children in kindergarten, second grade, and special classes are assessed for signs of obvious decay. This indicator is the percent of children in these grades who have had their cavities filled and have no decay. In the coming year, fifth-graders will be added to this dental assessment.
How is Wake County doing: In the past 10 years, Wake County's children have shown a 9.2% increase in the percentage of children who have no obvious signs of decay upon screening. Four out of five children screened in kindergarten and second grade have no obvious signs of decay; a sign of good prevention or appropriate treatment for dental caries.
Percent of Students Screened with No Obvious Tooth Decay, Wake County, 1989-1998 School Years
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Indicator: TANF Client Employment
Why indicator was selected: While unemployment rates in Wake County are low, the county's booming economy does not always translate into instant employment. Many Work First clients need work and life skills to help them obtain and maintain good jobs. The many support services WCHS provides make it essential that we monitor TANF client employment, not only for the state and federal governments, but also to be accountable to our citizenry.
How indicator is measured: The number of Work First Participants who obtain employment.
How is Wake County doing: The state set a goal of 1,336 Wake County Work First participants to obtain employment in Fiscal Year 1999. Wake Work First participants exceeded this goal significantly; 2,363 went to work. The goal for fiscal year 2000 is 887 Work First Participants obtaining employment, which was achieved by the end of the second quarter of the fiscal year.
Number of Work First Participants Obtaining Employment by Quarter
Indicator: Employment Maintenance (TANF)
Why indicator was selected: Once a TANF client has obtained a job, it is important that they maintain that job. This is not only for the earned income the job generates, but also as a stepping stone to better-paying jobs. The ability of a client to hold down a job for a period of time indicates that the support network the client already has, as well as support provided by Human Services, are working well. While Human Services cannot take credit for the client's job success, this indicator allows us to track the percentage of clients who keep their job for more than three months.
How indicator is measured: Retention rates are measured as the percentage of families who had a breadwinner obtain employment since 1995 and are still employed at the time of the report.
How is Wake County doing: As of November 1999, Wake County and the state have the same percentage of Work First clients who are off assistance, 92%.
Percent of Work First Participants Still Employed, as of November 1999
Source: N.C. Department of Health and Human Services, DSS, Economic Independence, January 24, 2000
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Years of Potential Life Lost
Why indicator was selected: Years of Potential Life Lost is a measure that reflects premature death among residents. In an area where health practices and preventive services are good, and good health care is available, people will be more likely to live to reach their life expectancy. This indicator is a broad measure of the health status of the community.
How indicator is measured: This rate is derived from the aggregate number of years of premature death on death certificates of persons ages 20 and older per 100,000 resident population in that age range. If the person lives beyond their life expectancy, the number of years added to the tally is zero, but no credit is given for living beyond the expected time. Death data come from the State Center for Health Statistics, where death certificates are compiled annually.
How Wake County is doing: Wake County's aggregate years of life lost rates are lower than the state in total and in each race/sex category for the years 1995-1997. Total rates for Wake County are nearly 35% lower than those of the state.
Years of Potential Life Lost Rates
Source for the associated graph is State Center for Health Statistics
Vaccine Preventable Disease Rate
Why indicator was selected: The immunization rate is more a measure of utilization of care, while the Childhood Vaccine Preventable Disease Rate reflects not only missed opportunity for treatment, but also is an important "red flag." One way we use this rate is in identifying migration of communities into Wake County who have not been properly immunized. Another is to quickly identify cases of rare diseases which need immediate attention. Most of the cases of childhood diseases are among immigrants who were immunized with poor vaccines, or more likely, were never immunized.
How indicator is measured: Wake County Human Services maintains a database of reportable diseases for its residents. Reportable diseases are required by the state to be reported within seven days. While there is some underreporting of diseases, this is still the most reliable source of disease data available. The diseases that are considered childhood vaccine-preventable are: measles, mumps, Hepatitis B, pertussis, Hemophilis Influenza B (invasive), polio, tetanus, diphtheria and rubella.
How Wake County is doing: Wake County's rate of childhood vaccine-preventable disease has fluctuated greatly over the past five years. The rates were higher in 1993 due to a mumps outbreak, and pertussis (whooping cough) increased in 1995-1997. In 1998, pertussis cases were down, but hemophilis influenza invasive disease was up, as was Hepatitis B.
Childhood Vaccine-Preventable Disease Rates, Wake County, 1993-1998
Source: State Center for Health Statistics
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