Parker County

Child Health Summit Doss Heritage and Culture Center
February 12, 2013

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Today’s Learning Objectives:
1. Discuss how to utilize new information about children's health in
Denton County. 2. Describe Cook Children's Health Care System's next community children's health action steps. 3. Define their individual role and personal commitment to improving the overall health of children.

Conflict of Interest Disclosure:
Neither I nor my immediate family members have any commercial interest in any amount that creates an actual, potential or perceived conflict of interest.

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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KEEPING OUR PROMISE
Knowing that every child’s life is sacred, it is the promise of Cook Children’s to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Top child health issues for Cook Children’s

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Cook Children’s is committed to…
Giving our community access to the data and the tools to act

Continuing to use the data to research, understand and communicate children’s health issues and potential solutions

Creating a “Center for Children’s Health” to sustain this effort

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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The Center for Children’s Health

Our Goal:
The Center for Children's Health will oversee CCHAPS, community research and health outreach, with the goal of creating aligned collaborations that will lead to improved child health outcomes.
Provided for the benefit of the children in our community by:

The Center for Children’s Health

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CCHAPS Region Coalitions . . .

Wise Coalition for Healthy Children Child Abuse Prevention

Wellness Alliance for Total Children’s Health [WATCH] of Denton County
Mental Health

Healthy Children Coalition for Parker County
Childhood Obesity

Safe Kids of Tarrant County The Mental Health Connection Children’s Oral Health Coalition Healthy Tarrant Co Collaboration Save a Smile Immunization Collaboration and MANY OTHERS Johnson County Alliance for Healthy Kids
Childhood Obesity

Hood County for Healthy Children
Child Abuse Prevention

Provided for the benefit of the children in our community by:

Health Children Coalition for Parker County
led by Cook Children’s

Provided for the benefit of the children in our community by:

CCHAPS 2012

Provided for the benefit of the children in our community by:

Comparing the surveys Parker County

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County 2008
314 58.9% 41.1% 5.1% 0.3% 0.6% 0.3% 91.4% 1.6% Total Surveys Boys Girls Hispanic Asian African American Native American Caucasian Multi-racial
Provided for the benefit of the children in our community by:

2012
343 54.5% 45.5% 9.3% 1.2% 0.0% 0.3% 85.7% 2.0%

Source: CCHAPS 2008 and CCHAPS 2012

The Center for Children’s Health

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Parker County

2012
Answered CCHAPS 2008

18.7%

Number of years in this community:
0 – 5 years 6 – 10 years 11 – 15 years 16 – 20 years 21 – 30 years 31+ years

31.2% 34.4% 14.9% 6.7% 5.8% 5.5%

Provided for the benefit of the children in our community by:

Source: CCHAPS 2008 and CCHAPS 2012

Notable changes

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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6-County children population ages 0 – 14:
2008 2012 11,462 12,385 2008 2012 138,153 174,505

4-year Growth = 8.0%

4-year Growth = 26.3%

2008 2012

20,550 23,337

2008 2012

401,322 436,629

4-year Growth = 13.6%

4-year Growth = 8.8%

2008 2012

8,820 9,897

2008 2012

32,214 38,441

4-year Growth = 12.2%

4-year Growth = 19.3%

Our six-county’s population ages 0 – 14 grew 13.5% over a four year period from 612,526 in 2008 to 695,194 in 2012. Future growth is projected at a rate of 9.2% for an estimated 759,449 children 0 – 14 by 2017.
Provided for the benefit of the children in our community by: Source: The Neilson Company, Thompson Reuters: Demographic Expert 2.7

The Center for Children’s Health

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NOTABLE CHANGES

Children's general health improved
In general how would you describe your child's health? Excellent / Very 2008 2012
Good
n = 7,439 n = 8,394

Denton Hood CCHAPS Region Parker Tarrant Johnson Wise National Texas

88.4% 85.2% 84.8% 84.7% 83.7% 83.4% 81.9% 84.0% 78.0%

90.6% 90.6% 87.1% 92.7% 85.2% 86.8% 89.0% 84.0% 78.0%
Provided for the benefit of the children in our community by:

Source: CCHAPS 2008, CCHAPS 2012 and the 2007 National Survey of Children’s Health (1,805 surveys in Texas ages 0 – 17)

The Center for Children’s Health

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NOTABLE CHANGES – in Parker County

Easier to access children's health services
How easy is it for you to get the following types of health care services: 2008 2012
Very Easy / Easy
n = 314 n = 175

Immunizations Care for short term illness Preventive health care Preventive dental care Treatment of injuries Treatment for dental problems or pain Care for long-term illness Specialized care for specific conditions Mental health care

84.1% 81.8% 86.0% 76.4% 65.9% 68.5% 48.7% 45.5% 22.9%

92.0% 91.4% 90.3% 88.6% 84.6% 87.4% 61.1% 66.3% 44.6%

Provided for the benefit of the children in our community by:

Source: CCHAPS 2008 and CCHAPS 2012

The Center for Children’s Health

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NOTABLE CHANGES – Parker County
A change in awareness / health literacy . . .
Very familiar / Familiar

2008
n = 149

2012
n = 175

. . . types of dental health services . . . where to get information about child health issues . . . types of health care services available . . . types of preventive programs . . . types of social services . . . types of mental health services

58.4% 57.0% 55.7% 27.5% 24.2% 20.8%

77.1% 78.3% 73.7% 43.4% 40.0% 34.3%

Provided for the benefit of the children in our community by:

Source: CCHAPS 2008 and CCHAPS 2012

Childhood asthma

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: ASTHMA

2008
n = 314

2012
n = 343

Lifetime asthma:
17.2% 17.2%

Boys at greater risk:
21.1% 18.2%

Provided for the benefit of the children in our community by: Source: CCHAPS 2008 and CCHAPS 2012

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: ASTHMA
2012
n = 343

Currently has asthma
12.2%
n = 22

Has an action plan
68.2%

Uses inhaler > twice a week
13.6%

Night symptoms > twice a month
13.6%

Refills inhaler > twice a year
13.6%

ED with asthma in last year
13.6%
Provided for the benefit of the children in our community by:

Source: CCHAPS 2012

Childhood dental and oral health

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: DENTAL

2008
n = 165

2012
343

dental exam in last 12 months
83.0% 78.0% 74.0% 77.0% 13.2% 84.5% National State 79.0% 10.3%

teeth cleaned in last 12 months received all needed dental care little/no affect on general health
51.0% 99.0%
Provided for the benefit of the children in our community by: Source: CCHAPS 2008 and CCHAPS 2012

79.0% 99.0%

prevention very important

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: DENTAL

2012
n = 343

Flouride varnish in last 12 months
58.0%

Dental "work" in last 12 months
25.4%

Toothache in last 6 months
4.4%

Decay or cavities in last 6 months
12.0%

Provided for the benefit of the children in our community by:

Source: CCHAPS 2012

Mental health or childhood emotional, behavioral and mental wellness
Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: MENTAL

2008
n = 149

2012
n = 343

A diagnosed mental health issue
10.1% 4.7%

Bullied at school
12.8% 9.9%

Experienced a trauma
9.1% 4.1%

Had self-esteem issues
15.2% 9.6%

Provided for the benefit of the children in our community by: Source: CCHAPS 2008 and CCHAPS 2012

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: MENTAL
2012
n = 343

Child was cyber-bullied
0.3%

Family environment: Harder to care for than others
11.4%

Angry with child in last 30 days once or more
every day every other day once a week once never 0.6% 1.7% 26.3% 26.3% 44.6%
Provided for the benefit of the children in our community by: Source: CCHAPS 2012

Childhood safety from unintentional injury

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: SAFETY

2008
n = 149

2012
n = 175

Accident in last 12 months requiring medical attention
20.8% 15.4%

Bike helmet > 1 block away
45.0% 51.4%

Bike helmet < 1 block away
39.6% 42.3%

Properly "buckled-up"
98.0% 96.6%

Provided for the benefit of the children in our community by: Source: CCHAPS 2008 and CCHAPS 2012

Childhood safety from abuse and neglect

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: ABUSE
or
8.0%
1,727 7.4%

7.0%

6.0%

5.0%

4.0%

or
793 3.4%

822 4.0%

3.0%

2.0%

1.0%
0.0% 0.0% 0.0% 0.0% 0.0%

0.0% Taken to a family violence shelter Emergency Shelter due to homelessness Foster Care or Voluntary Placement CPS Investigation

= Statistically better = Statistically worse
N = 149 for 2008 and 175 for 2012

2008

2012

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: ABUSE
4.0%

3.5%

698 3.4%

3.0%
554 2.7% 411 411 2.0% 397 1.7% 256

2.5%

2.0%

2.0%

1.5%

1.0%
147

1.1% 147 0.6% 144 0.7% 0.0%

0.5%

0.6%

0.0% Physical Abuse Neglect Sexual Abuse Physchological Abuse Gang Threat

= Statistically better = Unchanged
N = 149 for 2008 and 175 for 2012

2008

2012

Provided for the benefit of the children in our community by:

Childhood obesity

childhood weight management, activity and nutrition
childhood cardiac risk
Provided for the benefit of the children in our community by:

or

or

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: OBESITY

2008
n = 304

2012
n = 317

BMI = overweight or obese
31.3%
n = 149

(age 2- 14)

31.6%
n = 343

Concerned child is overweight
8.1%
n = 149

5.8%
n = 343

or

Eats healthy meals
79.0% 86.6%

Provided for the benefit of the children in our community by: Source: CCHAPS 2008 and CCHAPS 2012

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: OBESITY

What's new?
2012
n = 175

Fruit but no vegetables yesterday
12.0%

Vegetables but no fruit yesterday
8.6%

No vegetables or fruit yesterday
2.9%

Provided for the benefit of the children in our community by: Source: CCHAPS 2012

The Center for Children’s Health

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Seen in a bike shop in Telluride, CO

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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OVERWEIGHT and OBESE defined for children
According to the Centers for Disease Control and Prevention: Body Mass Index (BMI) is a number calculated from a child's weight and height. BMI is a reliable indicator of body fatness for most children and teens. For children and teens, BMI is age- and gender-specific.
EXAMPLE Age Gender Height Weight BMI Percent Weight Status 8 years Male
Underweight

Weight Status based on BMI results

30.6 kg 17.4 76.0% Normal

"Normal" weight

0% 5%

85%

95%

Provided for the benefit of the Source: “About BMI for Children and Teens” Centers for Disease Control children in our community by: and Prevention Web site accessed November 8, 2010.at www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Obese

132.5 cm

Overweight

The Center for Children’s Health

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Parker County Profile of Children aged 0 – 14: OBESITY

• 12.8% or nearly 3,000 children’s
parents in Parker county report they do not eat healthy meals

• Exercise is related to academic
and behavioral problems in school

• 31.6% or more than 7,300
children are overweight or obese

• 38% of children under 5 are
already overweight or obese

Provided for the benefit of the children in our community by: Source: CCHAPS 2012

The Center for Children’s Health

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Children’s weight status by COUNTY
Based upon BMIs calculated from parent reported height and weight adjusted for age and gender

40% 35%
Average = 32%

37% 32% 29% 27% 18% 32% 20% 24%

37% 16%

30% 25%

17%

16%
20% 15% 21%

10% 9%
5% 0%
HOOD
n = 139

12%

14% 12%

13%

DENTON
n = 1949

PARKER
n = 317

TARRANT
n = 4842

JOHNSON
n = 458

WISE
n = 155

CCHAPS n = 7,860 children ages 2 - 15

Overweight

Obese

Provided for the benefit of the children in our community by:

Source: CCHAPS 2012

The Center for Children’s Health

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Children’s weight status by AGE
Based upon BMIs calculated from parent reported height and weight adjusted for age and gender

70% 60% 50%

10%

35%

61% 42%

23%

38%

24%

33%

18%

48%

34%

26%

30%

16%

16%

40%
24%
Average = 32%

30%
20%

31% 21% 18% 15%

32%

13%
19%

15%

19%

7%

21% 15% 8% 8% 13 Age 14

10% 0%

14%
5% 5% Age 2 8% 4% 3 4 5 6 7 8 9 10 11 12 9% 11% 11%

7%

CCHAPS n = 317 children ages 2 - 14

Overweight

Obese

Provided for the benefit of the children in our community by:

Source: CCHAPS 2012

The Center for Children’s Health

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Children’s weight status and ASTHMA
Based upon BMIs calculated from parent reported height and weight and age adjusted for growth and development

40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0%

Total = 30.7%

Total = 36.2%

Obese, 13.8% Obese, 18.9%

Overweight, 11.8% "NO" to Asthma

Overweight, 22.4%

"YES" to Asthma
Provided for the benefit of the children in our community by:

CCHAPS n = 312 children ages 2 - 15

Source: CCHAPS 2012

The Center for Children’s Health

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Children’s weight status and HOURS OF SCREEN TIME
100%
Under weight, 6.7% Under weight, 7.7%

90%
80% 70%
"Normal" weight, 26.7% "Normal" weight, 40.7%

60%
50% 40% 30% 20% 10% 0% Screen Time >2 Hours
CCHAPS n = 121 school aged children ages 5 - 14
Provided for the benefit of the children in our community by:

Obese or Overweight, 34.3%

Obese or Overweight, 30.8%

Screen Time <2 Hours

Source: CCHAPS 2012

The Center for Children’s Health

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Do you believe this child eats healthy meals? “NO”
35.0%
32.0%

30.0%

Parker county average:12.8%
24.0% 23.0% 21.0%

25.0%

20.0%
15.0% 15.0% 14.0% 14.0% 13.0% 11.0% 11.0%

15.0%

10.0%

5.0%
0.0% 0.0% 0.0%

3.0%

0.0% <1 Age 1 2 3 4 5 6 7 8 9 10 11 12 13 Age 14

CCHAPS n = 343

Provided for the benefit of the children in our community by: Source: CCHAPS 2012

The Center for Children’s Health

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Healthy meals and children’s performance in school
Eats Healthy Meals 25% Does Not Eat Healthy Meals

Children not eating healthy meals are 2.1 times more likely to experience academic problems than those eating healthy meals

20%

21%

15% 14%

Children not eating healthy meals are 1.5 times more likely to experience behavior problems in school than those eating healthy meals

10%

10%

9%

5%

0% Academic Problems
CCHAPS n = 209 school aged children 7 - 14
Provided for the benefit of the children in our community by: Source: CCHAPS 2012

Behavior Problems

The Center for Children’s Health

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Children’s weight status and physical activity
Based upon BMIs calculated from parent reported height and weight and age adjusted for growth and development

60%
53.4% 47.1%

50%

Children whose BMI places them in the underweight status show no significant difference based on how often they exercise. Children who exercise, increasingly achieve a normal weight status based on their BMI as the number of days exercised increases Increasing the number of days of exercise has the greatest impact on reducing the number of children whose BMI places them in the overweight and obese status

40%

30%
27.5% 23.5%

20%

10%
5.9% 5.3%

0%
Underweight Normal Weight Overweight & Obese

Days per week of exercise 30 mins < 3 days 4+ days
CCHAPS n = 209 school aged children 7 - 14
Source: CCHAPS 2012

Provided for the benefit of the children in our community by:

www.centerforchildrenshealth.org

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

slide 48

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

PARENT RESOURCES
www.cookchildrens.org/Checkup

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Provided for the benefit of the children in our community by:

SO NOW WHAT?

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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The World Health Organization and the United States’ Centers for Disease Control and Prevention agree:

80% of all chronic disease is preventable

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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Leading cause of death in US for all ages?
10,000,000

71.2% 
1,000,000 1,443,607

2,471,986
518,607

18.9% 
616,828

1

100,000

10,000 1950

2

1,000

2008

100

35.9%
10

25.4%

1 Total Deaths
Sources: 1Public Health Reports. Vol 67, No. 1, January 1952. Prepared by the National Office of Vital Statistics of the Public Health Service 2Deaths: Leading Causes for 2008. Volume 60, Number 6 June 6, 2012, National Vital Statistics Reports. USDHHS, Centers for Disease Control and Prevention, National Center for Health Statistics

Deaths from Heart Disease

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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SO, What determines our HEALTH?
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Physical Health: eating well and being physically active.

Lifestyle = 50%

Mental Health: cope / manage stress for a healthy outlook Social Health: interacting / appreciating time with others Spiritual Health: a healthy, loving faith relationship

Environment = 20% Genetics = 20% Medical Science = 10%

Environmental Health: protecting the conditions in which we live Intellectual Health: value / active in learning new information. Occupational Health: supporting a productive life
Provided for the benefit of the children in our community by:

Source: March 1997. J. Of Public Health Mgmt. and Practice

The Center for Children’s Health

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INCENTING BEHAVIOR?
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 95-98% Medical Science and Service 2-5% Preventive Care

Provided for the benefit of the children in our community by: Source: M.Hartman, A.Martin, J.Benson, A.Catlin, the National Health Expenditure Accounts Team. National Health Spending In 2011. Health Aff January 2013 vol. 32 no. 1 87-99

$2.7 Trillion in Annual HEALTHCARE

The Center for Children’s Health

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20 bright, well-intentioned people; brilliantly executing 20 perfectly designed improvement efforts,

Gap

IMPROVED HEALTH

cannot make a difference if they are going in 20 different directions.

Provided for the benefit of the children in our community by:

Adapted from and used with the permission of Insightformation, Inc.

The Center for Children’s Health

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Every person in the child’s ecosystem. . . . . . is needed to make a difference
PUBLIC POLICY ENVIRONMENT (Social) ADVOCACY GROUPS ENVIRONMENT (Natural) ENVIRONMENT (Built) GOVERNMENT

PHILANTHROPY

SERVICE ORGANIZATIONS

PUBLIC HEALTH

BUSINESS

MEDICAL CARE SCHOOL FAITH

ACADEMIA and RESEARCH

CHILD

FAMILY

INSURERS

Copyright 2011, Cook Children’s Health Care System All Rights Reserved

Provided for the benefit of the children in our community by:

The Center for Children’s Health

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BUT, if those people work on a common agenda with mutually reinforcing actions, shared measures and constant communication

IMPROVED HEALTH

– we will have a positive “collective impact” on the health of our children.
Provided for the benefit of the children in our community by:

Adapted from and used with the permission of Insightformation, Inc.

The Center for Children’s Health

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Children 0-14 are 21% of Parker County’s population.

But they are 100% of our FUTURE
Provided for the benefit of the children in our community by:

The Center for Children’s Health

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THANK YOU FOR YOUR HELP “KEEPING OUR PROMISE”
Provided for the benefit of the children in our community by:

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