Community Actions in 2008-2009

Age 0 to 1 Year-Infant

1. Beginning with prenatal care through an infant’s second year of life, the Cleveland MomsFirst Project is designed to improve birth outcomes and ensure a healthy start for babies by providing support to high-risk pregnant women and teens.  Core services include outreach, case management, health education and interconceptional care.  The project also provides screening and referral for perinatal/postpartum depression.

Specific Actions from 2008 to date:

• MomsFirst submitted a successful federal funding application securing 5 years of continued funding through May 2014.
• Collaboration between MomsFirst and Help Me Grow continued throughout 2008 blending the strengths of both programs; MomsFirst’s prenatal expertise and Help Me Grow’s child development skills. In lieu of changes in the structure of the Help Me Grow program in the State Fiscal Year 2010 the referral process between the programs was modified in early 2009.  Families now remain in the MomsFirst project until the child turns two and receive enhanced interconceptional care and child development screening services.
• MomsFirst conducts developmental screenings on all children enrolled in the program in an effort to identify children at risk for developmental delays. Any child that scores out of range is referred to Help Me Grow for further assessment to determine Medicaid Part C eligibility.   
• MomsFirst capacity has been increased through annual Invest in Children funding to serve an additional 386 families prenatally.    
• In collaboration with Planned Parenthood of Greater Cleveland, MomsFirst provides free reproductive health care services for men and women on board the HealthMobile.  The partnership has increased STD and HIV/AIDS screening across Cleveland neighborhoods.  Targeting adolescents, 456 gonorrhea and chlamydia tests and 422 HIV/AIDS tests were performed on board the HealthMobile during 2008.    
• MomsFirst continues to make Capitol Hill visits each spring to educate our elected officials on the new initiatives taking place within the Project and the issues impacting infant mortality.  
• MomsFirst entered into a number of public awareness activities including several Radio One Life Campaign public service announcements on such topics such as the importance of folic acid (January 2009).  A full page article, “Infant Mortality in the City of Cleveland”, ran in the August 12, 2009 Back to School section of the Call and Post.  Additionally, a Safe Sleep campaign was launched in collaboration with Cuyahoga County’s Health and Human Services Department which featured a press event, a Plain Dealer article, a Channel 20 interview, Radio One and Clear Channel radio broadcasts (June – July 2009), and expanded distribution of the Safe Sleep cards by the City of Cleveland EMS staff.
• MomsFirst, in collaboration with a number of community partners, hosted nine community engagement and education events across the city during the month of September 2009 for National Infant Mortality Awareness month.  Each event provided interactive educational activities and exhibits promoting prenatal care, safe sleep, medical homes, and infant mortality awareness. 
• In partnership with the Child and Family Health Services Initiative, MomsFirst administered educational messages addressing barriers to safe sleep practices through June 2009. MomsFirst also assists families in need of a safe sleep environment obtain a crib or portable sleeping unit (Pack-n-Play). 
• MomsFirst continues to participate in the recruitment of eligible families for lead abatement services.  In 2008, 765 families were referred to have their homes assessed for lead and remediated.
• All MomsFirst sites hold neighborhood consortia meetings to educate the 1community-at-large about the following topics: preterm labor, safe sleep, smoking cessation, substance abuse, STD/HIV/AIDS prevention and testing, and perinatal depression.
• The Project continues to distribute copies of “A Guide for Moms” throughout the community.  Developed in 2003, the guide is an easy to read compilation of numerous resources for both mothers and providers.  In July 2005 the Ohio Department of Mental Health announced plans to fund reproduction and state-wide distribution of “A Guide for Moms”.  The Guide is now in use in all counties within the state.   
• MomsFirst staff are focusing Project efforts on increasing the percentage of women who breastfeed within two weeks postpartum and increasing the percentage of quit attempts among smoking participants.  
• In a separate project, MomsFirst has been a key partner in an effort to promote and support breastfeeding in the low income African American population through a home-based “breastfeeding doula” program for expectant and delivered mothers.
• Awarded continued funding from the Sisters of Charity Foundation (through March 2010) to expand implementation of the Baby Basics health literacy curriculum to all MomsFirst program participants. Baby Basics is a prenatal health guide based on the best selling book What to Expect When Your Expecting).  The book provides interactive, culturally sensitive prenatal education for expecting moms and also addresses and supports their need for literacy training and education.

2.  The Cuyahoga County Board of Health (in collaboration with the Child and Family Health Services Consortium, Northeast Ohio Neighborhood Services and East Cleveland Schools) continues to provide outreach to pregnant women and new families in East Cleveland.  A perinatal outreach nurse provides classes and counseling to pregnant teens in East Cleveland middle and high schools.  This nurse makes home visits to assess the health and welfare of the mothers and infants and makes appropriate referrals to address identified needs. 

3.  The mission of the March of Dimes is to improve the health of babies by preventing birth defects, premature birth, and infant mortality.  In January of 2003, the Ohio Chapter of the March of Dimes launched a multi-year campaign aimed at addressing the serious problem of prematurity.  As part of a nationwide effort by the agency, the Ohio campaign continues to focus on increasing public awareness of the severity of prematurity and educating expectant parents on the warning signs of preterm labor.  Additionally, the effort includes continuing education opportunities for health professionals and directing funding to prematurity related research.  The Ohio Chapter supports a NICU Family Support Initiative to provide education, information, and support to families of babies in the NICU.  The initiative emphasizes the importance of family-centered care. The Ohio Chapter has partnered with the American College of Obstetrics and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) in supporting the aims of the campaign.  March of Dimes advocacy efforts in Ohio include working towards expanded Medicaid eligibility for pregnant women and coverage for smoking cessation programs.

4. The Cuyahoga Child Fatality Review Program (CFR) revised the safe infant sleep cards previously developed and again distributed them throughout Cuyahoga County. These materials have been so well received that a fifth printing and distribution was done in 2009. 

5.  Through the Cuyahoga County Child Fatality Review Program, the Cuyahoga County Board of Health provided safe sleep or preterm labor education for 85 pregnant or parenting families at four MomsFirst sites from 2008 to 2009.   Safe sleep education was also done for 20 pregnant and parenting women at NEON.  A training on preterm labor, prematurity, and preconception care was given for the MomsFirst staff.   Nine safe sleep educational inservices were provided for 125 maternity nurses, pediatricians, and childbirth educators at local hospitals.  CCBH was also invited to present three safe sleep programs at the Alexandria Nanny School.

6. In 2008 Cuyahoga County Board of Health partnered with Radio One to provide information and demonstrations of a safe sleep environment to at risk populations in non-traditional settings such as church sponsored events, neighborhood block parties, and community health fairs.  Individual safe sleep education was provided to 450 people.  In 2009 we again partnered with Radio One at two health fairs to provide one on one safe sleep education to 260 parents and family members.

7. In order to increase awareness during the “National Infant Mortality Month” in 2008-2009, the Cuyahoga County Board of Health partnered with MomsFirst, Invest in Children, Cleveland Department of Health, and Radio One at 17 community events.  Safe sleep demonstrations and information were provided to 385 pregnant and parenting families.

8. The CFR newsletters are available on the Protecting Our Future website.  The topics include Prematurity, Suicide, Fire Safety, and Water Safety. In 2009 Gun Safety was added and Safe Sleep was revised.

9. In 2009 the Cuyahoga County Board of Health participated in six maternity licensure visits at local hospitals.  Areas of discussion included the number of sleep related deaths in the county, the importance of role modeling safe sleep in the hospital, and incorporating a discussion of safe sleep practices with parents and family members.

10. The Department of Children and Family Services line staff continues to distribute information about safe sleep environment to families with infants.

11. Cuyahoga County Help Me Grow (HMG) continues to focus on prenatal health, safe sleep and appropriate supervision as areas that have the most impact on child deaths in the birth to three year population. The following activities support our commitment to continued education in these areas: 

Safe Sleep

• Families receiving home visitation services benefit from our curriculum chapter on safe sleep.
• Cards with the safe sleep messages continue to be distributed to over 5,000 families participating in our ongoing services each year. Safe sleep cards are also distributed at area health fairs and events.
• All families complete a health and safety checklist with an emphasis on a safe sleeping environment.  The checklist is under revision to increase the focus on safe sleep and extending the safe sleep message to secondary caregivers.

Prenatal Health and Wellness

• HMG maintains a referral agreement with Cleveland’s MomsFirst Program and the Ohio Infant Mortality Reduction Initiative (OIMRI) at North East Ohio Neighborhood Health Services (NEON) regarding referral protocols for expectant families.  The collaboration coordinates our prenatal services to families throughout the county.  Prenatal home visits connect the family with medical and social services; answer questions about prenatal care, birth control, and family planning; and provide the family with parenting support.
• HMG regularly distributes educational materials, such as the Ohio Department of Health Help Me Grow Guide to Wellness and Development for Families and Parents-to-Be, containing information on the warning signs of pre-term labor, information on smoking cessation and the dangers of secondhand smoke.
• Families served prenatally continue to benefit from our home visiting curriculum that emphasizes healthy prenatal habits, the importance of prenatal care and preparing for childbirth.

Supervision/Safety

• A health and safety checklist for is completed by all families in order to identify potential household and environmental hazards.
• Our home visiting curriculum addresses appropriate supervision of infants and young children.

12.  MetroHealth continues to offer a high-risk prematurity clinic to help parents of fragile pre-term babies avoid SIDS, encourage optimal development, and learn positive parenting and nutritional concepts.

13.  MetroHealth providers and Help Me Grow child-find specialists include education on safe infant sleep practices and adequate adult supervision of children as part of well-child check-ups and Help Me Grow activities.  

14.  MetroHealth providers routinely screen for substance abuse in the obstetric and adolescent clinics, as well as in the newborn nursery and NICU.

15.  The MetroHealth WIC program distributes safe sleep cards to new pregnant mothers at the time of postpartum certification.

16.  The Cuyahoga County Board of Health launched a three year Shaken Baby Syndrome (SBS) education and training program in 2002.  When the three year program ended in 2005 there were 1636 professionals trained in Cuyahoga County who work with families and children aged birth to three years.  An educational DVD was developed and is available for continued training.  The Cuyahoga County Board of Health provides SBS training to the cadets at the Police Academy on a yearly basis.  Since 2005 an injury prevention grant through ODH has been obtained to educate teachers and students about Shaken Baby Syndrome.  There were 1161 participants trained in 2006, 1565 participants in 2007, 1603 participants trained in 2008 and 1784 people trained so far in 2009.

17.  The Cuyahoga County Witness/Victim Service Center provides information and education about the importance of educating clients who access services regarding a wide variety of issues related to safe infant sleep practices, adequate adult supervision, and general infant safety.

18.  Invest in Children (IIC) is a community-wide, public/private partnership of the Board of County Commissioners that mobilizes resources and energy to:

• Ensure the well-being of all young children in Cuyahoga County.
• Provide support services to parents and other persons who care for these children.
• Build awareness, momentum and advocacy in the community around children and family issues.
• IIC achieves these goals through efforts to forge a comprehensive early childhood system for families in the county.  IIC funds organization that:
  • Work with pregnant parents to improve birth outcomes
  • Provide support to families with a child with a delay or disability
  • Prevent child abuse
  • Provide treatment services for families with children who have serious socio-emotional and behavioral issues
  • Enroll children in Healthy Start
  • Prevent lead poisoning
  • Encourage the establishment and use of a medical home
  • Work to improve the quality of child care
  • Provide support to families and child care providers working with children with special needs
  • Provide a high quality preschool experience to better prepare children for school            

In addition, IIC has endeavored to strengthen this early childhood system through other efforts as well.  Through the work of IIC’s Perinatal Strategy Committee -which brings together service providers, experts in the field, and local stakeholders – efforts are underway to:

• Assure a seamless system of perinatal services in Cuyahoga County
• Decrease the rate of poor birth outcomes in Cuyahoga County
• Increase perinatal mental health services capacity in Cuyahoga County through the development of a comprehensive perinatal mental health plan.  As another example, families may access any service in the system by engaging just one service, a concept known as “no wrong door.”  IIC has also made it possible for multiple service providers, working with the same family, to work collaboratively in a coordinated way.  IIC has assisted in developing information systems that enable service providers to better coordinate their efforts.  Lastly, IIC has sponsored a rigorous, objective evaluation of these service strategies to demonstrate their impact.

Age 1 to 5 Years-Early Childhood

19.  The Special Investigation Unit (SIU) at DCFS continues to perform a comprehensive record review for all fatalities in which the deceased child was involved with the agency at the time of the fatality and/or during the previous 12 months. Lessons learned from investigations contribute to ongoing staff development throughout the agency, particularly in the areas of safety planning and prevention.

20.  DCFS has expanded the number of our neighborhood collaboratives in order to better help support our families and children. There are two additional neighborhood collaborative sites that DCFS has contracted with bringing the collaborative count to 14.  We believe this is part of a prevention effort that allows children and families to be served safely in their homes.

21.   DCFS continues to use a new parenting project program entitled “Parents Helping Parents Project”. This involves a mentoring style program in which previous DCFS clients can provide help, support, and feedback to current DCFS clients

22.  DCFS is heavily concentrating on our 2006 strategic plan priority issues. These include:

Continuous Quality Improvement: Improve services to families and overall agency performance by implementing a self-initiated, all encompassing program that promotes quality outcomes. This well-defined process serves to anticipate opportunities for improvement, incorporate preventative measures, and establish standards for success.

Racial Equity: Identify and address the disproportionate representation of certain ethnic, racial, age, socio-economic status or gender groups within DCFS while engaging other county systems and our neighborhood partners.

Effective Teaming: Strengthen communication and collaboration to ensure that services provided to children and their families are timely and well coordinated. This includes working on consistency of agency policies, internal teamwork, and collaboration as well as strengthening external partnerships.

Safety and Permanency: Ensure that all children have a safe, stable, and permanent family through services and programs that reflect best practices, are consistent with agency policies, and are timely and well coordinated.

23.  The Medical Investigation Unit has added an ongoing case management component to service families with medically fragile children, or children who have suffered severe abuse.  The social workers in the medical unit have advanced training and experience with complicated medical issues and have developed a relationship with medical providers.  This enables them to work more efficiently with families to insure the children’s needs are being met.  The Medical Investigation Unit also does consults on cases which are already active in other departments.

24.  Grand Rounds presentations to the departments of Pediatrics at MertoHealth have included lectures on child abuse.  These lectures are often given at the Cleveland Clinic and Fairview General Hospital, as well.

25.  MetroHealth has served as a resource to the Cleveland Clinic physicians involved in developing their own child abuse and neglect consultation service.

26.  Case School of Medicine students regularly receive lectures on child abuse issues during their clinical pediatric clerkships at MetroHealth Medical Center.  MetroHealth Pediatric residents also receive training in the behavioral effects of child abuse.  

27.  MetroHealth hosts an ongoing monthly meeting with DCFS to improve collaboration between the two agencies and to update policy information.

28.  MetroHealth is participating in the DCFS initiative on improved recognition of factitious-fictitious illness of childhood.

29.  The MetroHealth Department of Social Work conducts regular presentations on domestic violence, child abuse and neglect, substance abuse, and mental health issues for medical providers throughout the system.

30.  Rainbow Babies & Children’s Hospital Injury Prevention Center is dedicated to preventing unintentional injury—the leading killer of American children.  The Center’s mission is threefold 1) to work directly with children and families through education and outreach to decrease injury risk, 2) to share creative ideas, resources, and information with all members of the greater Cleveland community interested in protecting children, and 3) to advance the body of knowledge in unintentional injury prevention research.  The Center also serves as the lead agency for the Greater Cleveland Safe Kids/Safe Communities Coalition and has a staff of experts in many injury areas, including child passenger safety, sports safety, teen and senior driving safety, fire safety, and unintentional firearm injury prevention. 

The center engaged in a wide variety of injury prevention activities and community outreach during 2008, as described below

• Child Passenger Safety Program
  Research shows that 4 out of 5 child restraints are installed incorrectly or are inappropriate for a child’s age, height, and/or weight.  Misuse can have potentially tragic consequences, yet puzzling directions, a wide variety of seats on the market, and a huge array of vehicles and seat belt systems can add up to major confusion for parents.  The Rainbow Injury Prevention Center provides parents with help in choosing and installing car seats through the Rainbow Car Seat Fit Stop, located in the Adelbert Road garage, and at checkup events throughout the region.  During 2008, Rainbow held 15 free child safety seat checkup events in 5 counties, checking 449 car seats, while an additional 722 seats were checked at the Rainbow Inspection Station.
• Help for Economically Disadvantaged Families
  The Rainbow Injury Prevention Center coordinates child passenger safety seat education and distribution efforts in a multicounty area to increase child safety seat usage among economically disadvantaged families.  In 2008, we distributed 308 free or subsidized child safety seats to income-qualified families in Cuyahoga County, Lake, Geauga, Medina, and Summit counties.   ·        
• Booster Seat Advocacy
  The Rainbow Injury Prevention Center worked in support of a booster seat bill introduced in the Ohio House during 2008. The staff prepared answers to frequently asked questions for the public and lawmakers, drafted issue briefs for our state and national partners, and prepared testimony for individuals speaking on behalf of the bill. The booster seat bill was signed into law in January 2009.
• Booster Seat Public Information and Education Campaign
  To promote booster seat use for children who have outgrown child restraints, but are too small for seat belts alone,  the Rainbow Injury Prevention Center created a traveling visual display that helps parents gauge whether children who are too big for child restraints would be safest in booster seats or seat belts—the Boost Your Booty display has been used throughout the county during 2008 and was the focal point of the Rainbow activities at several large-scale events during the year, including Parade the Circle family festival that draws thousands of families each June.  Rainbow staff provided booster seat education to 4,192 children and parents during 2008. The Rainbow Injury Prevention Center also distributed 200 free booster seats to families with age and weight appropriate children at community events during 2008.  Billboards throughout Greater Cleveland and public service announcements on the local PBS station also spread the Boost Your Booty message.  
• Special Needs Transportation
  The Rainbow Injury Prevention Center is home to the first and only special needs car seat program in Northeast Ohio.  Many children have short or long-term challenges that prevent them from fitting correctly into a conventional child restraint, placing them at risk for additional injury.  The staff worked closely with the orthopedic department regarding casts and the NICU staff for low birth weight and preterm infant special needs.  Rainbow provides specialized car seats and motor vehicle restraints to patients’ families on a loaner basis or at a reduced cost. There were 39 special child restraints loaned during 2008.
• Protecting Families from Impaired Drivers
  Despite the public perception that children who are killed in impaired driving crashes were the victims of irresponsible strangers, most children killed are riding with the impaired driver.  To stress the need for people to think twice before getting behind the wheel after having a few drinks—particularly during the holiday season where adults are more likely to combine social drinking with family activities—the Rainbow Injury Prevention Center and the Greater Cleveland Safe Kids Coalition host a Holiday Mocktail Party each year to highlight the dangers of impaired driving, stress the need for designated drivers, and provide fun and creative options for celebrating without alcohol.  At the 9th annual Holiday Mocktail Party in November, 2008, approximately 450 Safe Kids/Safe Communities members and community partners came together to sample 16 different mocktails and vote for their favorites. 
• Protecting Kids from Unintentional Poisoning
  The Rainbow Injury Prevention Center collaborates with the Greater Cleveland Poison Control Center, also based at Rainbow, to increase community awareness about the dangers of poisoning for young children.  During 2008, the Center distributed 48,000 educational brochures, handouts, and magnets with the Poison Center number throughout the five-county region served by the center.  Staff members from the Rainbow Injury Prevention Center appeared at community events, such as health and safety fairs, and conducted presentations to PTAs, parent groups, and other forums that bring together caregivers of young children, making more than 60,000 contacts.

31. The Cuyahoga County Witness Victim Service Center (WVSC) provides information    and education about the importance of educating clients who access services regarding mental health alerts in children, general child safety, adequate adult supervision, safe gun storage, and inter-generational domestic violence.

32. WVSC collaborates with the Department of Children and Family Services (DCFS) in       developing enhanced strategies such as the requirement to assess for domestic violence related issues at the time of initial contact with a family and then continuously throughout that family’s involvement with DCFS.  This collaboration has also developed a protocol and direct referral process to provide ongoing domestic violence individual and group counseling for adult victims of domestic violence when such services are part the individual case plan.  Further, as the county home of the Children Who Witness Violence Program, WVSC staff is participating in DCFS workers’ training in recognizing trauma that is being offered by Mental Health Services as a part of a new SAMSHA funded project.

33. Witness Victim Service Center further promotes child safety by being the home of the Violence Against Women Safe Havens Grant, a program providing supervised visitation and safe exchange services through a contract with the Domestic Violence Center.  Opened three years ago and operating in tandem with services provided through a TANF grant, the supervised visitation project is already operating at full capacity and contemplating expansion.

34. Currently, Cuyahoga County Witness Victim Service Center is reactive in the area of a child fatality. The majority of clients who access the agency, do so in a response to violence which they and /or a family member have experienced or been the victim of. Within the intake and assessment phase of advocacy intervention, safety planning is essential and a part of every intake. The concern for the safety and well-being of children is paramount within the process. Information, verbally and in the form of brochures, is given to clients.

35. On-going updating and training are part of the staff enrichment and presented to the     staff in a variety of milieus. Witness/Victim is available for outreach and education in the community. Presentations to schools, human/social service providers, medical personnel and law enforcement are means of linking Witness/Victim to the needs of the community at large. Witness/Victim is in the process of reorienting itself as an agency from reactive to proactive education, information and advocacy.   

Age 6 to 12- School Age

36. Preteens Seat Belt Program
The “Pause to Click” multimedia contest, supported by Kohl’s, is an educational program designed to reach preteens at a stage when restraint use rates begin to drop and kids start moving to the front seat.  Middle school students throughout Northeast Ohio were invited to take part in the contest, which challenged students to create artwork, songs, and public service announcements that shared the seatbelt message with their peers.  Kids throughout the county rose to the challenge and submitted wonderfully creative entries.  Finalists had a chance to perform or screen their entries live onstage at Parade the Circle. The winners—and their messages encouraging kids to wear their seat belts and sit in the back seat—were showcased in high visibility venues throughout the summer: the winning entries in the PSA and poster contests were screened as part of pre-movie entertainment at movie theaters throughout the county, and the winning song was showcased on KISS-FM (96.5) through on-air spots and streaming media on the Clear Channel station’s website.  Billboards throughout the county also carried the Pause to Click message throughout 2008. 

37. International Walk to School Week
Each October the Rainbow Injury Prevention Center organizes a countywide effort to promote pedestrian safety during International Walk to School Week.  Approximately 2,500 children in elementary schools in Cleveland, Parma, Shaker Heights, Highland Heights, and Berea celebrated in 2008 with combinations of group walks, assemblies, and pedestrian safety activities for children and families.

38. Halloween Pedestrian Safety Campaign
The Rainbow Injury Prevention Center and the Greater Cleveland Safe Kids/Safe Communities Coalition joined together to raise awareness of the added need for pedestrian safety on Halloween.  Children’s excitement about costumes and candy and the novelty of being out at night can lead them to forget safety habits—like proper street crossing—that they practice during the light of day.  Our community partners play an important role in talking to children and families about safety issues.  With this in mind, we provided them with special Halloween treat bags that could be distributed to children.  In addition to being made of a retroreflective material that helped young trick-or-treaters be seen, the bags were printed with safety tips for children and parents.  Coalition members distributed 10,000 bags in communities throughout a multicounty area.  In partnership with Cleveland EMS, Rainbow staff also led more than 200 K-5 students in the Cleveland Public Schools through interactive Halloween safety demonstrations.

39. Night Out Against Crime
On August 5, 2008, Rainbow joined Cleveland Mayor Frank Jackson and a wide range of community groups in support of Cleveland’s Night Out Against Crime.  More than 800 people attended the anti-violence rally held in the heart of a neighborhood besieged by violent crime.  The event included activities and performances designed to spotlight the positive things children in the community are doing and offer young people constructive alternatives to the crime and violence in the area.  The Rainbow staff had direct contact with 400 children in interactive games and activities designed to promote healthy behaviors and build self esteem and a sense of community.

40. Poison Prevention Awareness
During Poison Prevention Awareness Week, March 16-22, e-mail messages were sent throughout the UHCMC system providing poison prevention information and publicizing Rainbow’s resources.  The Rainbow Injury Prevention Center also prepared a poison prevention curriculum for students from kindergarten through 6th grade, complete with age-appropriate lesson plans, activities, and worksheets, which was distributed by mail to over 200 elementary schools in our five-county region.  The Injury Prevention Center also held its third annual Poison Prevention Awareness Week Poster Contest, with more than 1,400 elementary school students participating.  

41. Protecting Families from Fire
The presence of a working smoke alarm can mean the difference between life and death when a fire breaks out in a house or apartment, yet residents of the highest-risk areas—low income urban neighborhoods—are the least likely to have working smoke alarms.  During 2008, the Rainbow Injury Prevention Center provided 458 smoke detectors free of charge to Greater Clevelanders and provided fire safety education programs to more than 500 children through appearances at Safety Towns, schools, and recreation centers.  Fire prevention materials were also distributed to nearly 4,000 families in 2008. 

42. Protecting Young Bicyclists
The Rainbow Injury Prevention Center maintains an active bicycle safety program that includes fun, child-oriented presentations to schools and community groups throughout the region and a bulk bike helmet purchase program that allows schools and community groups to save significantly on the cost of helmets.  During 2008, 911 low-cost bicycle helmets were distributed throughout a multi-county area, while an additional 455 free helmets were distributed in low-income areas.  Nearly 2,000 children were educated on bike safety through bike skills courses, school assemblies, and other events.  In addition to Rainbow’s direct outreach to the community, our Ready to Roll kit allows schools, police, or other community agencies to borrow the supplies and instructions needed to conduct their own bike safety rodeos.

43. Parade the Circle
This annual cultural celebration takes place every June in University Circle, drawing approximately 50,000 spectators.  After watching the parade, spectators can visit Circle Village to take part in an array of fun crafts and activities.  The Rainbow Injury Prevention Center booth at the Parade the Circle focused on child passenger safety—from car seats, to boosters, to seat belts.  The Boost Your Booty display helped parents and children learn what transportation method was safest for them.  Nearly 800 children participated in the activities at the Rainbow booth.

44. Kids Fun Days at Jacobs Field
Kids and their families attending select Cleveland Indians’ games could visit a special activity area where Rainbow Injury Prevention Center staff and volunteers led them through an array of interactive safety-themed games.  Children had the chance to decorate t-shirts, while parents learned more about booster seats and motor vehicle safety.

45. Boo at the Zoo
The Rainbow Injury Prevention Center and the Greater Cleveland Safe Kids/Safe Communities Coalition partnered with the Cleveland Metroparks Zoo to educate parents and children about pedestrian safety issues in the fun and safe setting of the annual Boo at the Zoo event.  The more than 43,000 visitors attending the eight day event took part in hands-on stations centered around the theme “Be Safe, Be Seen this Halloween,” including a retroreflective activity that stressed the need for kids to be visible when walking or biking at night, a pedestrian safety-themed tic-tac-toe game, and pedestrian safety crafts.  Safety tip sheets were also distributed to parents throughout the event.

46. Teddy Bear Day at the Cleveland Metroparks Zoo
Children who visited the Rainbow Injury Prevention Center booth at the zoo’s annual Teddy Bear Day learned about poison prevention and the importance of hand washing.  Approximately 6,000 people attended the event.

47. Teaching Young People to Be Safe Babysitters
The Rainbow Injury Prevention Center offers Safe Sitter classes for children aged 11 to 13 throughout the Greater Cleveland area.  The program is designed to teach young people basic child care skills and prepare them to recognize and respond to emergencies when caring for other children.  During 2008, Rainbow trained 215 young people from more than 27 cities in Northeast Ohio through 18 classes. With the aid of a grant, the Rainbow Injury Prevention Center launched a special series of Safe Sitter classes through the City of Cleveland Recreation Department in 2008.  The Safe Sitter course was provided free of charge to 59 children in low-income Cleveland neighborhoods.  This program met a need in the community by giving children in high-risk inner city families the skills they needed to create a safe environment for younger children left in their care.

48. The Rainbow Injury Prevention Center “Street Team”
The Rainbow Injury Prevention Center’s “Street Team” consists of college-aged students who bring injury prevention messages directly to children and parents each summer through interactive presentations at child care centers, schools, health fairs, recreation centers, summer camps and other community venues.  From May to August of 2008, the Street Team members took part in 119 presentation s and events reaching more than 18,000 children and adults with important safety messages on topics including child passenger safety, bike safety, brain injury prevention, water safety, and fire safety.

Age 13 to 17 –Adolescence

49. Cuyahoga Tapestry System of Care
The Cuyahoga County Community Mental Health Board (CCCMHB) launched “Project Tapestry” in the fall of 2003 to increase access to services for children with mental health needs and their families.  “Project Tapestry” was originally designed to serve 240 children with serious emotional disturbances each year for five years, for 1200 children served.  The project has since evolved into a multi-system initiative of established community partners known as the Cuyahoga Tapestry System of Care (CTSOC).  CTSOC has identified 800 additional children in need of services and is developing a strategic plan to serve their needs.  The ADAMHS Board served as the fiscal agent for the CTSOC, managing the six year matching grant from the Substance Abuse and Mental Health Services Administration (SAMHSA).  When the six year match expires this year another Cuyahoga County division will continue to fund the program.

50. The Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County continues to distribute the Red Flags booklets at health fairs and upon request.  Red Flags presents in simple language the signs in a child’s behavior to watch for which might indicate a seriously troubled child.        The video produced by CCCMCH, “Living With It: Youth Talk About Depression”, continues to be distributed to schools and organizations.  The video is part of a kit which gives suggestions for use, fact sheets, and recommended actions for teachers to take if they suspect that a child is depressed.  The Parent2Parent Network held an event for parents and students in May 2008 that was a two part program about youth and depression that featured the video followed by a question and answer session with panel experts.

51. School-based Mental Health Services
In the School-Based Mental Health Services Program the mental health needs of students are identified and addressed by on-site clinicians who provide counseling, community support services (CPST), assessment, prevention, and consultation.  The collaboration with school personnel increases the opportunity to prevent more serious difficulties, including suicide.  

The Alcohol, Drug Addiction, and Mental Health Service (ADAMHS) Board of  Cuyahoga  County has taken the lead, in collaboration with school districts and community mental health agencies, to deliver publicly funded mental health services within the schools.  Through school-based mental health services, youth with mental health issues can be identified earlier and access to services improved.  The program provides prevention and early intervention to enhance social/emotional development and prevent more serious problems.  Intensive treatment is available when needed.  

During the 2007-2008 school year school-based mental health services were     delivered to 3000 students in 110 schools of the Cleveland Metropolitan School District.  There are also a number of collaborative ventures in many of the suburban school districts.

Seven ADAMHSBCC contract agencies provide school-based mental health services and work with school personnel to coordinated referrals and services and implement programming that meets the needs of students.      

52. The Cuyahoga County Suicide Prevention Plan  
The Cuyahoga County Suicide Prevention Plan, which was written in 2003, has continued to be implemented by the Suicide Prevention Task Force.  The Task Force is comprised of approximately forty members including representatives from systems, agencies, hospitals, schools, and faith-based organizations, as well as suicide survivors.  Patterned after the state and national suicide prevention plans, the Cuyahoga plan addresses the areas of awareness, intervention, and methodology through goals, objectives and activities.

Plan goals include:

• Increase awareness that suicide is a public health and mental health problem in order to reduce stigma and increase people’s ability to seek help.
• Reduce factors that increase the risk of suicide.
• Collect additional data about suicide attempts and evaluate the effectiveness of programs designed to prevent suicide.

Plan implementation includes gatekeepers’ trainings that target all ages.   Information is also gathered about school-based suicide prevention activities to identify unmet needs. 

Suicide Prevention Awareness Campaign

The Cuyahoga County Community Mental Health Board’s (CCCMHB) [now the Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board of Cuyahoga County] Suicide Prevention Awareness Campaign is part of the Suicide Prevention Plan.  The purpose of the Suicide Prevention Awareness Campaign is to reach as many citizens of Cuyahoga County with the revised message; Do you know someone thinking about suicide? and to direct people who are in need of help or more information to the ADAMHS Board of Cuyahoga County’s 24-hour suicide prevention, mental health information, and referral line for adults and children – 216-623-6888.  This hotline is operated by Mental Health Services, Inc.

The Suicide Prevention Awareness Campaign first ran from February 2005 through June 2005 and consisted of billboards, RTA placards, RTA interior posters, mall posters, and 15 second television spots that aired on TV 3 and TV 23.  The campaign was re-run from November 2005 through February 2006.  In March 2006 the 15 second TV spot was digitalized to show in the 20 minute time period before every movie on every screen in the four Regal Cinemas in Cuyahoga County through May.  At the end of April 2006, the 15 second spot, along with the billboard were made into a slide that appeared in the six Cleveland Cinemas in Cuyahoga County through June 2006.  The billboard and bus placard components were run again from November 2006 through March 2007.  From July 2008 through January 2009, new commercials on News Channel 5, two noon news interviews and a presence on NewsNet5; commercials on Village TV and BET, and radio commercials on 1220 AM The Word, WERE 1490 AM, 107.3 The Wave, and 93.1WZAK, were new features that were added in addition to the billboards and the RTA bus placards.  In August of 2009, radio spots were rerun on 95.5 The Fish and 1420 WHK.  Suicide is the third leading cause of death among teenagers and young adults ages 15-24, and the fifth leading cause of death among 5-14 year olds.  Accordingly, the campaign targets all age groups including children and their families.      

53. A Cuyahoga County Witness Victim Service Center staff member will meet with middle school aged children at a local elementary school regarding conflict resolution.  Meetings are also held with faculty to highlight the need to be aware of “red flags” for suicide among young students.

54. The Cuyahoga County Witness/Victim Service Center (WVSC) is a participating agency in the Cuyahoga County Suicide Prevention Plan.

55. The Cuyahoga County Witness Victim Service Center also serves as an agency participant on the Cuyahoga County Domestic Violence Coordinating Council and participates in presentations and facilitation of discussion groups at various high schools on topics of domestic violence and violence in teen relationships.

56. The Department of Children and Family Service has added a program to provide Multi-Systemic Therapy (MST) to families with at-risk teens.  MST services provide intensive, in-home therapy based services to the family for up to six months.  The Cuyahoga Tapestry System of Care is also expanding to be able to serve more families with at-risk youth.  Tapestry System of Care uses wraparound services to meet a family’s needs.  The focus is on building a team of natural and formal supports in the community to “wrap around” the family and develop a plan of care.

57. Teen Seat Belt Program
The Use It or Lose It High School Seat Belt Challenge is an educational and outreach program designed to encourage teens to buckle up and drive responsibly.  During 2008, 11 high schools competed to have the highest student seat belt use rate.  The Rainbow Injury Prevention Center provided a comprehensive curriculum and guide to schools to help them plan their education efforts and student groups at each school took ownership of the program and worked hard to increase awareness and convince their peers to always buckle up. At the end of the 3 week education and outreach program, schools had an average 11 percentage point increase in seat belt use by drivers entering and exiting student parking lots.  The program also provided incentives for students to take part in creative contests in which they created songs, posters, and videos to influence their peers to always buckle up and ride safely.  Contest finalists appeared on stage at Cleveland’s House of Blues during the county’s Click It of Ticket seat belt mobilization kickoff.

The Rainbow Injury Prevention Center also worked with our law enforcement partners to conduct prom and homecoming themed campaigns during 2008 to encourage seat belt use through a combination of heightened law enforcement and public information and education.

58. Juvenile Justice has continued to work with Integrated System of Care (Tapestry) which supports collaboration with other community agencies and systems to provide wrap around services to youth and their families. This is a family centered approach to case management.

59. The Juvenile Justice Placement Unit was reorganized to be more community focused.  A team approach to placing children out of the home is used (Alternative Case Planning Team) to provide better screening and insure public safety.  Children are provided with a Placement Officer at the time the order is made.  Plans start immediately to reunite the family. 

In June 2009 the YFCP program was added.  Children are referred by a court order.  If they are accepted, a Placement Officer is assigned.  The children may spend a short time in a placement facility before they are released to community based services.

A position has been added to screen youth entering the Detention Center with domestic violence charges to evaluate them for community based services through Systems of Care.

60. The Juvenile Justice intake department uses an assessment tool to screen unruly youth for needs and services which provides a more individualized plan.  The court also provides an avenue for parents to come together and support each other in the Parent Support Group.      

61. The Behavioral Health / Juvenile Justice (BH/JJ) project is a community based model alternative to secure care in detention environments for adolescent female juvenile offenders with serious behavioral issues.  Female youth are served in this project in lieu of out-of-home placement.  This is a collaboration among Juvenile Court, the Alcohol, Drug Addiction, and Mental Health Services Board, Family and Children First Council, and the Department of Children and Family Services.

62. Delinquency Drug Court is a voluntary program for non-violent youth with substance        abuse issues.  New services have been added for youth exhibiting mental health         symptoms as well as substance abuse disorders.           

63. Family Drug Court works with parents whose children are alleged to be abused,  neglected, or dependent and are at risk of losing their children because of drug dependency.    

64. Mental Health Court targets youth who have been identified with mental health issues.

65. Reentry Court is a new initiative that targets gang identified youth being released  from the Ohio Department of Youth Services.  This is being piloted in one or two  Cleveland neighborhoods.