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2014-379-Minutes for Meeting May 28,2014 Recorded 7/15/2014 DESCHUTES NANCY BLANKENSHIP,FCOUNTY CLERK ps CJ 704.319 COMMISSIONERS' JOURNAL 07/15/2014 08;14;31 AM kItIiIiJJ 1111111111111111 111 Do not remove this page from original document. Deschutes Count y Clerk Certificate Page ,,,, s0 , ,,, 0 #46 ,,,f-, 4410014N, , ...,..„ „.,_ di-ES oweeetc,ilk Deschutes County Board of Commissioners 1300 NW Wall St., Suite 200, Bend, OR 97701-1960 ;,,; (541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org MINUTES OF BUDGET MEETING DESCHUTES COUNTY BOARD OF COMMISSIONERS WEDNESDAY, MAY 28, 2014 — Morning Session Allen Room, Deschutes Services Building Present were Commissioners Tammy Baney, Anthony DeBone and Alan Unger. Also present were Tom Anderson, County Administrator; Erik Kropp, Deputy County Administrator; Mike Maier, Clay Higuchi and Bruce Barrett, Budget Committee; and,for a portion of the meeting, Wayne Lowery, County Finance Director/Treasurer; David Givans, County Internal Auditor; Teri Maerki, County Financial/Budget Analyst; and Deschutes County Health Services staff Jane Smilie, Director; Scott Johnson, outgoing Director; David Inbody, Operations Manager; Melissa Rizzo, Developmental Disabilities Program Manager; DeAnn Carr, Behavioral Health Deputy Director; Sherri Pinner, Business Manager; Tom Kuhn, Community Health Program Manager; Hillary Saraceno, Regional Early Learning Hub Manager; and Jodie Barram, Bend City Council Member. Meeting minutes were taken by Kathe Hirschman, Deschutes County Health Services. Mr. Barrett (chair of budget committee) opened the meeting at 2:45 p.m. Jane Smilie introduced Health Services staff present and began the presentation. Fiscal Year 2013-2014 was a year of extraordinary change for the department. g p Oregon Health Plan (OHP) membership continues to grow; Deschutes County gained over 13,000 new members from 2013 to 2014. The department will keep tracking the numbers to make sure service capacity matches the demand. County general funds are critical to meet safety net services for the uninsured those in crisis and those released from jail. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 1 of 8 Sherri Pinner distributed. FY 2015 budget by programs for Funds 259 and 270, and explained the department's three-year forecast for Medicaid funding to sustain essential services. The department's ending fund balance is projected to be $2 million at the end of the three-year forecast. Mr. Maier noted that the forecast shows a trend that the contingency funds will be gone in FY 2017, and the department should not look to County general funds to cover. Ms. Pinner noted that the forecast is specific to OHP revenues and OHP expenditures and is a worst- case scenario based on information currently available. Typically, more up-to-date information about funding adjusts the forecast to be better as we get closer to the dates that are projected here. Mr. Higuchi noted that actual funds from the State of $7.4 million, which goes up to $10 million, is the increased per-member-per-month capitated rate for expanded. OHP. Mr. Higuchi's concern is that the amount coming to us is not keeping up to expenses as we look farther out. This is a rolling target and the forecast is continually updated based on current information as it becomes available. The region is required to update the current Health Assessment and Health Improvement Plan in 2015. This is an opportunity and should guide the department's and the region's work in setting priorities and moving together to have an impact. Between 2006 and 2015, the average annual increase in personnel related costs has been 9.2% and the County general fund increase has been 2.1%. This is mostly related to public health programs; OHP covers most of the cost in behavioral health programs. OHP expansion has been huge driver over the past year. The department has received 15 new State grants in public health and behavioral health. There was a reduction in State general funds which has mainly impacted our safety net services—those services we are mandated to provide as the Community Mental Health Provider. The department passed the Triennial Review by the State Public Health Division with flying colors, and 93 of the 98 Public Health Accreditation standards were either substantially or fully met. The department has added 23.1 FTE; expanded services in Redmond and. La Pine; and got medical sponsors for all five School Based Health Centers. The department's core responsibility is to assure the health of our residents. We are becoming more diligent about translating broad County Goals and Objectives into measurable objectives. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 2 of 8 We post quarterly progress reports on how we are performing with our measurable objectives to move the County goals forward. The Program Budget narrative speaks to County general funds received and what services are provided with those funds. Common themes for use of County general funds across all the department's programs are to fill gaps in funding to assure all citizens receive services they are eligible for, to provide matching funds to maximize federal funding; to provide essential administrative and operational support; to advance the Triple Aim with prevention services; to fulfill our responsibility to protect the health and safety of residents. According to the State Public Health Division, county general fund is the second highest funding stream for public health services across Oregon. Deschutes County's general fund contribution is 26%, which is comparable to the State average. The departments request for County general funds in 2014-2015 is $156,100 (approximately 3.7% increase over FY 2014 level. The bulk of this is to provide funding for staff positions $110,200 for psychiatry, a jail diversion case manager, therapy for young children; health assessment update; and an internship within County government for an individual with developmental disabilities. Mr. Maier asked whether this request was included in the proposed budget. Tom Anderson explained that it is currently funded out of contingency funds and the department is requesting it be provided by an increase in County general fund. The total amount in the budget coming from County general fund is $2,766,000 in public health and $1,377,000 in behavioral health—the same level of funding as the prior year. This request is for additional County general fund. Scott Johnson noted that the gaps can be covered this year out of contingency funds, but they cannot be covered long-term out of contingency. Mr. Johnson explained that OHP members lose their coverage when incarcerated. This benefit is lost even if the individual is not adjudicated yet—while the individual is incarcerated pre-trail. The department has the responsibility to serve these individuals when they are released, and before OHP coverage is obtained, and coordinates with the jail to do so. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 3 of 8 Ms. Smilie explained that for each piece of the staffing request the department plans to blend the County general funds with OHP funding so that staff can serve those with OHP and the under- and un-insured. In addition to the staffing outlined above, the department is requesting $13,500 to implement an e-learning system that will help with risk management and compliance, and $32,400 to help the department replace computer equipment as required by the Information Technology department. Funds are needed for the e-learning system and computer replacement for public health staff only as the behavioral health budget has sufficient funds. Mr. Higuchi asked whether the $13,500 and $32,400 are one-time expenses or an ongoing commitment. Ms. Smilie clarified that a portion of the employee development would be ongoing and the technological improvement would be one- time. Mr. Maier asked why there had been a big increase in behavioral training expense. Most of the increase was due to sending staff to a national behavioral health conference and training conferences for behavioral health electronic health records staff Commissioner Unger asked whether the e-learning system would help reduce disallowed expenses because staff will train online rather than travelling. Mr. Johnson replied that it would reduce travel expenses and would also provide the department a more efficient and effective method of tracking which staff have taken which trainings. The expense of the e-learning system has been included in the proposed budget but there is not an offsetting revenue item. Mr. Anderson asked whether there will be legislative initiative next year to change the OHP rules to maintain coverage of incarcerated individuals. Mr. Johnson explained that this would require change in federal law. Commissioner Baney noted that the Governor does have discretion as to whether or not to suspend coverage and that he did decide to suspend rather than terminate. Now the infrastructure has to catch up and we need a fast-track method of getting their coverage back. This is a big topic at the State level. The County transferred 2.5 FTE prevention staff from the Children & Families Commission to Health Services in FY 2014 to continue prevention services. County general funds in the amount of$26,451 included in FY 2014 for operating and indirect costs related to those 2.5 FTE were not included in Health Services budget in FY 2015. The department is requesting these funds be reinstated into Fund 259 to maintain the current level of service. Children & Families Commission general fund was reduced by that amount but Health Services budget was not increased by that amount. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 4 of 8 Increasing community access remains a priority for the department—bringing services to individuals throughout the County. A sampling of data from just three program areas behavioral health, family planning and WIC shows that more than 12,000 individuals have benefitted from these services in Sisters, Redmond, La Pine, Bend and north Klamath County over the past year. The number served in outlying areas is expected to increase as new facilities open. DeAnn Can- gave an overview of behavioral health services and priorities. The department aims to provide timely and effective access at accessible locations and to support whole-person health via integration and by expanding the continuum of care and services that support health. Prevention education and outreach will be increased. Safety net functions will be a critical piece. As more individuals enroll in OHP, we will also have an increasing population that is underinsured and will still have a significant gap that the County will be responsible for as a safety net provider. Hillary Saraceno distributed an Early Learning System handout. The Early Learning Hub is a tri-county effort with Crook and Jefferson Counties targeting children 0-6 years old who are at-risk. The comprehensive budget for children's services in the region is $18.8 million; the Hub is responsible to make sure these funds are used effectively. Total Early Learning Hub budget is $1.3 million, which. includes State, Maternal Child Health, High Desert Education Service District, Medicaid, and County funding. When our regional Hub is certified, there will be additional resources that will offset funding currently provided by the Counties. Commissioner Baney noted that Ms. Saraceno and the team have done incredible work in trying to engage the State in rolling this out and asked what is committed from the State to come into our region when we have been certified as the regional Hub. Approximately $660,000 for programs is expected to come to the region, 14% of which will be designated to cover the administrative costs of all the participating providers. WEBCO will need to decide how that will be allocated. Commissioner Baney reminded the Budget Committee that these funds will go not only to the Counties but also to other providers. We need to decide what is Deschutes County's contribution to the Hub in future. Because we have wanted to be at the forefront, we have been doing this work, and Commissioner Baney is concerned that there may be an understanding in the other Counties that because we've been funding the work, we'll continue to do so. Ms. Saraceno feels there is an understanding at the State level that it cannot be just the Counties and that discussion about this in the legislature is coming. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 5 of 8 Mr. Johnson described the work done over the past year to get more help from other communities agencies for the School Based Health Centers (SBHC) in order to reduce reliance on County general funds. Each. SBHC will provide primary care provided by the medical sponsors, behavioral health services provided by the department, and public health education for the entire student body provided by department public health nurses. Medical sponsors are either already providing services or coming on line at all seven SBHCs. Our partners are Mosaic Medical, La Pine Community Health Clinic, and St. Charles Medical Group. Advantage Dental is a critical partner as well and will be providing dental services, primarily at the Sisters SBHC. Last year we were using $550, 000 for the SBHCs; with the new medical sponsors, we have that number down to $363,000. The $190,000 in savings went to offset costs in Community Health, Reproductive Health, Maternal Child Health and WIC programs. Mr. Higuchi noted that the $190,000 saved did not reduce the general fund contribution but was used to cover costs in other program areas. The program budget document includes paragraphs describing what the general fund contribution does in each program area. The department has used the funds to offset the increase in cost to provide services. Commissioner Baney asked whether it would be safe to say that the $363,000 is our "fixed cost" now associated with the SBHCs. Mr. Johnson explained that we can't promise that this will be the case but the worst case scenario would be the $363,000 plus normal increases in indirect and administrative costs. Commissioner Baney cannot get over the hurdle of applying for a grant to stand up the SBHCs and not anticipating that the County general fund was going to be needed to go forward. She understands getting out there, because we can and feel we should do the project, but at the same time recognizes that the day is coming when things we have taken on really should not have been ours. The department is very confident that the SBHCs have incredible value as centers. Commissioner Unger noted that the SBHCs were a successful platform to help provide more County services than anticipated and wondered if the cost did not go down because we expanded services being offered at the SBHCs. Mr. Johnson explained that if the County had not gone forward with the Sisters SBHC we would have no place to provide our services in Sisters. We call it a SBHC but we can do a number of other things out of that location. If we were not constructing the SBHC we would still be looking at a lease commitment for another site in order to provide services in Sisters. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 6 of 8 Commissioner Baney stated that the Board does want to be providing services in Sisters and this is a way to do that effectively. Mr. Higuchi expressed concern about the growth of spending, so some action has to be taken. We just don't have n hmn the County enough money in t e Cou ty to cover this growth if, say in three years, it will be $2 million. We don't know if$363,000 is the number. We will have to wait and see, and then figure if$363,000 is worth it. Ms. Smilie summarized: the department's request is for $156,100 plus transfer of $26,451 from Children & Families Commission fund. The department is covering personnel related increases of$291,444. OHP behavioral health funds are up while public health funding is down. There has been a 23.1 FTE increase since FY 2014 budget was adopted. Accomplishments: increased access; integration efforts underway; regional EL Hub application submitted; demonstrated increased accountability; staff have navigated multiple and major changes successfully. Challenges: sustaining public health programs, services and protections; assuring timely OHP access; continuing attention to program compliance and performance; more changes on the way. Mr. Maier noted that contract payments in public health revenue went down more than 50%. Ms. Pinner explained that some of the change was due to the department using the proper revenue line and some were local grants that ended. Mr. Maier referred to the $1 million reduction in state grants on the behavioral health side and a $3 million increase in administrative fees and asked what type of administrative fees. Ms. Pinner explained that OHP capitation has increased. What used to be indigent clients with no coverage previously paid for with by State general funds are now OHP capitation clients who have covered benefits. Mr. Lowery explained that administrative fees are a percentage of the capitation amount provided by the State to cover the costs of providing the services. Mr. Anderson explained that he would like to see us get to the point where ideally we look at each service area and the Commissioners make policy decisions on the level of commitment to make in that service area. It is awkward without that kind of policy/financial process going on. If we could do that, it would make this process more meaningful with the ability to match up the policy decisions with dollars. Mr. Johnson noted that it would be very helpful to have a clear policy framework in which to operate and it would help with the department's strategic planning. Being no further discussion, the session ended at 4:23 p.m. Minutes of Budget Meeting Wednesday, May 28, 2014 Page 7 of 8 DATED this T' ' Day of 2014 for the Deschutes County Board of Commissioners (3,bitivv, Tammy Baney, Ch Anthony DeBone, Vice Chair ATTEST: n 0/14A-1/2 / rbkic,t■ Alan Unger, Commissioner Recording Secretary Minutes of Budget Meeting Wednesday, May 28, 2014 Page 8 of 8 BUDGET COMMITTEE AGENDA Tuesday, May 27t, 2014 Program Budget Tab/Page 9:00 AM • Elect Chair • Approve minutes from the December 2013 meeting 9:00 - 9:05 AM Sunriver Library County Service District (Fund 751) 13 / 379 (Budget Committee-Commissioners) • Open public meeting and introductions • Budget discussion • Public comment • Motion to approve budget of$102,975 and set amount of levy at $99,974 • Motion to be seconded • Budget Committee votes • Close budget meeting 9:05 - 9:20 AM Sunriver Service District (Funds 715 & 716) 7 / 273 (Budget Committee-Commissioners, Bob Wrightson, Jim Wilson & Mike Gocke) • Open public meeting and introductions • • Budget discussion • Public comment • Motions to: 1) Approve Sunriver Service District operating budget of $6,351,263 and set tax rate at $3.3100 per $1,000 of assessed valuation (Fund 715) 2) Approve Sunriver Service District Reserve budget of $1,149,122 (Fund 716) • Motions to be seconded • Budget Committee votes • Close budget meeting 9:20 - 9:35 AM Black Butte Ranch Service District (Fund 761) 7 / 265 (Budget Committee-Commissioners, Dave Sullivan, Tom Mayberry & Carl Burnham) • Open public meeting and introductions • Budget discussion • Public comment Motions to: • 1) Approve budget of$1,739,110 and set tax rate at $1.0499 per $1,000 of assessed valuation • 2) Set local option operating tax rate at $.5500 per $1,000 of assessed valuation Page 1 BUDGET COMMITTEE AGENDA Tuesday, May 27th, 2014 Program Budget Tab/Page Black Butte Ranch • Motion to be seconded Svc District(Cont'd) • Budget Committee votes • Close budget meeting 9:35 - 9:50 AM Deschutes County Extension and 4-H Service 7 / 268 District (Funds 720 & 721) (Budget Committee-Commissioners, Joe Cross, Mike Scholeman & Katrina Van Dis) • Open public meeting and introductions • Budget discussion • Public comment • Motions to: 1) Approve Deschutes County Extension & 4-H Service District operating budget of$699,835 and set tax rate at $.0224 per $1,000 of assessed valuation (Fund 720) 2) Approve Deschutes County Extension & 4- H Service District Reserve budget of$432,300 (Fund 721) 41, • Motions to be seconded • Budget Committee votes • Close budget meeting 9:50 - 10:00 AM Break 10:00 AM - Noon Deschutes County • Open public meeting • Deschutes County Budget Proposal Noon - 1:00 PM Capital Improvement Program (Lunch Discussion) 8 / 277 1:00 - 2:30 PM Other Funds Health Benefits Trust (Fund 675) 6 / 228 PERS Reserve (Fund 135) 6 / 237 Economic Development Fund (Fund 105) 6 / 229 Video Lottery (Fund 165) 6 / 223 Bethlehem Inn (Fund 128) 6 / 230 General Fund (Fund 001-00 and 001-45) 6 / 214 2:30 - 2:45 PM Break 2:45 - 4:45 PM Health Services 5 / 168 • Introductions • Budget discussion Continue the Deschutes County budget meeting to Wednesday, May 28th , at 9:00 AM Page 2 ATTACHMENT 7.3—Part 3b(5.2.7.1b) oei o c EL Hub of C.O.—DAS RFA#102.2183 c a C ;., w c v C p c c 'o o a v o U cn z o w w a a) E E V y c U U ?' ` 7- T •` _O V o - T C 8 .= U c i� U LI, t6 ' w - O V W'am E v, c"i V = = N W c ^o T E _ LL �+ 4111 et$ r O +' N u 6 t O a E Co E ,- 7- s" 2 ,_ E E �p o v a E o `LL° E v E o Q a Y o a a m o u 0 a, u L o c C CC ° • i U U d v, U Z 7 a s a6 u LL Q < w u.1 w - w -° u ��. a) c Z 0 C a C 'V •Z Q CO 3 m U = E Q1 ' ❑ Q 0 ,_ o 23 vi U 073 vi 0 cc Y O 41 0 C Q) `N Q W Y 7 p C +V, O a1 u O 0 = 06 C = O p a) O p_ "p m p 0 ii, o a, '�, o a v c E r = - m Co ch E C„ ... 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U • • • • o off '6. 0 s -1., C .w V V O O u o a Q 4 C3 14 U N O co -0 C +-, C U Vl'c i V J Q LIJ 0,„O _ w na co Q CO r E ? d a as o m U Co Q W 2 v Co a c v 0 ca v a To• w CO ►` v °° T. o a Q v.)i Z "6 a) V 4�-, U V., N 7•- y +-C N w C • Uj (i) C ,- o 06 V = ❑ co O I- u ,n C c�( �- d Q < a Q o ca "Q e Q v a O CO + N Y L CU LL U Q • d C 0 y v v, C U C C = J cid V d ¢ LL w d W < ch < U ec d LL cc 0 w ATTACHMENT 7.3—Part 3a (5.2.7.1b) EL Hub of C.O. — DAS RFA#201-2183- flQf niitinn of Kjndprpartpn Readiness Kindergarten readiness means young children have the skills, • knowledge, behaviors and attitudes necessary for success in school and in life. It includes aspects of six domains: . Physical Health and Development . Social and Emotional Development . Approaches to Learning . Language and Literacy Development . Cognition and General Knowled , . Cultural Awareness that enable children to engage in and benefit from learning experiences. In order for children to be ready, families need the resources to support learning, growth and development. Schools and communities need to work together to provide culturally relevant environments and experiences that advance child development from birth to kindergarten entry. Each component plays an essential role in W readiness and no one component can stand alone. Reodu Children +RPgclu Fornilipc + Reath' Srhnnic s, cervices Regaly Cnrnmiunitipc rhilclrpn Surceccf'al in .crhnnl Original document source from All Hands Raised- Multnomah Kindergarten Readiness Collaborative * revised by the Early Learning Hub of Central Oregon community partners to reflect The Head Start Child Development and Early Learning Framework Domains and to emphasize the importance of cultural awareness Requested Changes to Proposed Budget FY 2015 A) OHP-Mental Health Services(Fund 270) FY 2015 Proposed I Adjustment I Approved S Transfer Out to Fund 142 200,000 200,000 Contingency 4,729,510 (200,000) 4,529,510 Total Requirement Changes - • B) Jail Project(Fund 456) FY 2015 Proposed I Adjustment I Approved Transfer In from Fund 142 - 140,000 140,000 Total Resource Changes 140,000 New Construction 2,857,956 140,000 2,997,956 Total Requirement Changes 140,000 C) Sisters Health Clinic(Fund 464) FY 2015 Proposed I Adjustment I Approved Beginning Net Working Capital 140,000 210,000 350,000 Federal Grants - 220,000 220,000 Interest Revenue - 1,000 1,000 Total Resource Changes 431,000 Architecture/Design - 15,000 15,000 Interfund charges 359 - 359 Fees,Permits&SDCs - 5,000 5,000 Transfer Out to Fund 142 - 100 100 New Construction 139,641 410,900 550,541 Total Requirement Changes 431,000 D) General County Projects(Fund 142) FY 2015 1 0 Proposed I Adjustment I Approved Beginning Net Working Capital 1,780,000 (150,000) 1,630,000 Transfer In from Fund 270 200,000 200,000 Transfer In from Fund 464 - 100 100 Total Resource Changes 50,100 Transfer Out to Fund 456 140,000 140,000 Building Remodel - 250,000 250,000 Contingency 2,964,255 (339,900) 2,624,355 Total Requirement Changes 50,100 E) North County Services Building(Fund 462) FY 2015 Proposed I Adjustment I Approved Beginning Net Working Capital 540,000 (467,000) 73,000 Interest Revenue 3,000 (2,000) 1,000 Sale of Capital Assets - 2,500,000 2,500,000 Total Resource Changes 2,031,000 Architect/Design 40,000 560,000 600,000 Interfund charges 1,378 - 1,378 Water&Sewer 1,200 - 1,200 Fees&Permits 5,000 21,500 26,500 Electricity 10,000 - 10,000 Debt Service-Prinicipal - 150,000 150,000 Debt Service-Interest - 4,500 4,500 Capital Outlay-Unger Building - 1,000,000 1,000,000 Capital Outlay-Design Center 5,000 (5,000) • Capital Outlay-Antler 300,000 300,000 Transfer Out(to Fund 140) 480,422 480,422 Total Requirement Changes 2,031,000 Requested Changes to Proposed Budget FY 2015 F) Fair and Expo Center(Fund 618) FY 2015 Proposed I Adjustment I Approved Concession Food - 218,368 218,368 Concession Alcohol - 213,315 213,315 Catering Alcohol - 14,419 14,419 Catering outside @ 15% - 10,000 10,000 Catering - 146,914 146,914 Gratuity 18% - 26,445 26,445 Flatware Rental - 8,000 8,000 Kitchen Rental - 2,000 2,000 Total Resource Changes 639,461 Personnel Costs-Food/Bev Manager - 102,880 102,880 Materials&Serices-Food Costs - 176,767 176,767 Materials&5erices-Food/Bev Temp Help - 161,059 161,059 Contingency 218,814 198,755 417,569 Total Requirement Changes 639,461 • • • Y r u7 � ONOODO) N C) OD Co D3u70, CS7 - CO CD CD u7 1 C) C) LI, N ODU70 (0Q - C7N ONNC7CDCONOQo -o -o co Cc7h0rLOCN] ,c1- f17 'r0CD DMO - NrCDa) 3 ttitL O .r- t- C7OyNC�] CO r u7rCDt- 04)rOo � c= t^7 DO 4- h 0 'Cf St CD 0 0) CO O C) CD CO O co N N CO V• G � � � RD rNNN rNh CO Cbu) r u7Nr0 rN CO T' 06 c= r N a '47Nt- r r- i a. t. r 00 O ' ' 00x0 ' ' CD 07 to03 L) 71- 0 (0 CC) C4 r CD NIL h 0 0Or a) r 0) aCr7 CIO C771' cOCOCO 07 C) 0 0 0 0 a) C? 71.10 CO N CD t- c- co co co CD Cr)0LL N rC000 Cr) NONNc cccc "' u7 u7 Ch N r b u) Cl r^ Co r r CO r 10 7-- N r C‘1 uy W 01 ti 7,. 7- r r CO b? r CAF 0 ' co ' ' ' , CD ti 71• 't b ' 71• ' r CO ' Cl ' N N1 ca C W M N Cl CO N` co U) 0) co 0 71- OO m 1- u7 'Cr CO c'1 N to f- cO r 0) co CD CO c. u. 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It includes aspects of six domains: . Physical Health and Development . Social and Emotional Development . Approaches to Learning . Language and Literacy Development . Cognition and General Knowled , . Cultural Awareness that enable children to engage in and benefit from learning experiences. In order for children to be ready, families need the resources to support learning, growth and development. Schools and communities need to work together to provide culturally relevant environments and experiences that advance child development from birth to kindergarten entry. Each component plays an essential role in W readiness and no one component can stand alone. Reodu Children +RPgclu Fornilipc + Reath' Srhnnic s, cervices Regaly Cnrnmiunitipc rhilclrpn Surceccf'al in .crhnnl Original document source from All Hands Raised- Multnomah Kindergarten Readiness Collaborative * revised by the Early Learning Hub of Central Oregon community partners to reflect The Head Start Child Development and Early Learning Framework Domains and to emphasize the importance of cultural awareness