-  HHS Family of Agencies      -  HHS Agencies & Offices 
  -  Regional Offices 
  -  Advisory Committees, Task Forces & Initiatives 
  -  Organizational Chart 
-  Leadership 
-  Budget & Performance      -  FY 2025 Budget in Brief 
  -  FY 2025 Annual Performance Plan and Report 
  -  FY 2024 Contingency Staffing Plan 
  -  FY 2024 Budget in Brief 
  -  FY 2024 Annual Performance Plan and Report 
  -  FY 2023 Contingency Staffing Plan 
  -  FY 2023 Budget in Brief 
  -  FY 2023 Annual Performance Plan and Report 
  -  FY 2022 Contingency Staffing Plan 
  -  FY 2022 Budget in Brief 
  -  FY 2022 Annual Performance Plan and Report 
  -  FY 2021 Contingency Staffing Plan 
  -  FY 2021 Budget in Brief 
  -  FY 2021 Annual Performance Plan and Report 
  -  FY 2020 Contingency Staffing Plan 
  -  FY 2020 Budget in Brief 
  -  FY 2020 Annual Performance Report 
  -  FY 2019 Contingency Staffing Plan 
  -  FY 2019 Annual Performance Report 
-  Strategic Plan FY 2022 - 2026      -  Message from the Secretary 
  -  Introduction: About HHS 
  -  Overview: Strategic Plan FY 2022 - 2026 
  -  Strategic Goal 1: Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare 
  -  Strategic Goal 2: Safeguard and Improve National and Global Health Conditions and Outcomes 
  -  Strategic Goal 3: Strengthen Social Well-Being, Equity, and Economic Resilience 
  -  Strategic Goal 4: Restore Trust and Accelerate Advancements in Science and Research for All 
  -  Strategic Goal 5: Advance Strategic Management to Build Trust, Transparency, and Accountability 
  -  Appendix: Plan Updates 
-  News 
-  I Am HHS 
-  Careers 

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# FY 2022 Annual Performance Plan and Report - Goal 3 Objective 3

Fiscal Year 2022Released June, 2021

**Topics on this page:**Goal 3. Objective 3 | Objective 3.3 Table of Related Performance Measures

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## Goal 3. Objective 3: Support strong families and healthy marriage, and prepare children and youth for healthy, productive lives

Families are the cornerstone of America's social fabric.  People live longer, have less stress, and are more financially stable in a healthy family environment where both parents are present, share the responsibility of the household, and raise the children.  Additionally, in these households, children tend to be healthier, both mentally and physically, and are better able to have their fundamental needs met.  The Department supports healthy families and youth development through collaborations across the Federal Government and with states, territories, community partners, tribal governments, and faith-based organizations.

In the previous administration, the Office of the Secretary led this objective.  The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, CDC, HRSA, IHS, OASH, and SAMHSA.  HHS has determined that performance toward this objective is progressing.  The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

## Objective 3.3 Table of Related Performance Measures

Reduce the proportion of Head Start preschool grantees receiving a score in the low range on any of the three domains on the basis of the Classroom Assessment Scoring System (CLASS: Pre-K) (Lead Agency - ACF; Measure ID - 3A)

The ACF Office of Head Start (OHS) strives to increase the percentage of Head Start children in high-quality classrooms.  ACF measures progress by reducing the proportion of Head Start grantees scoring in the low range (below 2.5) in any domain of the Classroom Assessment Scoring System (CLASS: Pre-K).  This research-based tool measures teacher-child interaction on a seven-point scale in three broad domains: Emotional Support, Classroom Organization, and Instructional Support.  Research findings underscore the importance of teacher-child interactions as a demonstrated measure of classroom quality.  OHS assesses each Head Start grantee using the CLASS instrument during onsite monitoring reviews.  The most recent data from FY 2020 CLASS reviews indicate that 17 percent of grantees scored in the low range, which fell short of the target of 15 percent.

In FY 2020, ACF unveiled a rule to better improve the quality of Head Start services by refining the Designation Renewal System (DRS), which determines whether Head Start and Early Head Start agencies deliver high-quality and comprehensive services to the children and families.  The final rule on the DRS will become effective on October 27, 2020 and promotes increased quality in Head Start classrooms by establishing quality thresholds for each domain of the CLASS®.  Any grantee with a score below one or more quality thresholds will be designated for quality improvement.  For these grantees, OHS will provide support for quality improvement in teacher-child interactions and teaching practices.  Additionally, this rule raises minimum expectations for all grantees regarding quality of the classroom learning environment.  Any grantee with a score below one or more of the now higher minimum thresholds will be designated for competition.  The final rule is available at https://www.federalregister.gov/documents/2020/08/28/2020-17746/head-start-designation-renewal-system.  In FY 2021 and FY 2022, ACF plans to reduce the proportion of grantees scoring in the low range by at least one percentage-point, year over year.

Reduce the proportion of children and adolescents ages 2 through 19 who are obese (Lead Agency - CDC; Measure ID - 4.11.10b)26,27

CDC funds a number of interventions that target obesity as well as related chronic diseases.  The percentage of all children and adolescents (ages 2 to 19 years) that have obesity increased from 16.8  percent in FY 2008 to 19.3 percent in FY 2018, exceeding the target of 15.2%.  Despite this overall increase, there has been progress among children from lower-income families enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children.  Research shows behaviors that influence excess weight gain include early infant weight gain, lack of responsive feeding approaches, eating high-calorie, low-nutrient foods and beverages, not getting enough physical activity, sedentary activities, medication use, and sleep routines.  Public health and health care practitioners can educate individuals about healthy lifestyle choices and ways to improve their diet and increase physical activity.  However, it can be difficult for many children and parents to make healthy food choices and get enough physical activity due to underlying social determinants of health, which include housing insecurity, food insecurity, education, poverty).  Places such as child care centers, schools, or communities can affect diet and activity through the foods and drinks offered and the opportunities provided for physical activity.

In FY 2021 and FY 2022, CDC will continue promoting good nutrition and physical activity in children and adolescents to help prevent childhood obesity.  Through initiatives such as the Childhood Obesity Research Demonstration (CORD) project, CDC will continue to study and promote ways to prevent childhood obesity and its consequences.  For the first phase of the project, CORD 1.0, CDC examined whether a multi-level, multisector, coordinated strategy involving primary care and evidence-based public health interventions could help low-income children and their families increase healthier behaviors and prevent (primary prevention) and control (secondary prevention) obesity.  CORD 2.0 tested a model of quality clinical childhood obesity management for low-income families with an emphasis on assessing unmet social needs as part of the interventions.  For CORD 3.0, CDC is further increasing the availability of effective pediatric weight management interventions for children from lower-income families.  CORD 3.0 funds five recipients for five years (funding period 2019-2024).  During this phase, CDC will provide technical expertise and support to researchers to package their existing effective family-centered programs for use among low-income families through community sites that are feasible, convenient, and acceptable to diverse families.  This will include testing the packages in additional sites for comparable outcomes.  Community sites may include federally qualified health centers, community health centers, and clinics.

Maintain the proportion of youth living in safe and appropriate settings after exiting ACF-funded Transitional Living Program (TLP) services. (Lead Agency - ACF; Measure ID - 4A)

The Transitional Living Program (TLP) supports community-based, adult-supervised residences for youth ages 16 to under 22 who cannot safely live with their own families, or for whom living with their families provides undue hardships.  This long-term shelter program offers otherwise homeless youth housing for up to 18 months and provides the educational, employment, health care and life skills necessary for youth to transition into self-sufficient living.  The TLP safe and appropriate exit rate is the percentage of TLP youth discharged during the year who find immediate living situations that are consistent with independent living.  During FY 2019, TLPs met the 90 percent target for this measure by attaining a 90  percent safe and appropriate exit rate.

Because safe and stable housing is one of the core outcomes for the TLP program, ACF proposes to keep this performance standard and increase the annual target to 90 percent.  In FY 2021 and FY 2022, ACF will continue to work with grantees to ensure that appropriate service delivery and technical assistance systems are in place to provide increased support to at-risk youth.

(For adult-serving programs) Increase the proportion of participants who, at program exit, express positive attitudes towards marriage (Lead Agency – ACF; Measure ID – 22G)28

The Healthy Marriage Relationship Education Grant Program (HMRE) is part of HHS's community-based efforts to promote strong, healthy relationships; family formation; and maintenance of economically secure, two-parent, married families.  ACF HMRE grants fund 46 organizations that provide comprehensive healthy relationship and marriage education services and job and career advancement activities.

At program exit, adults in healthy marriage programs are asked the extent to which they agree or disagree with two statements: "It is better for children if their parents are married"; and "Living together is just the same as being married" (this statement is reverse-coded).  These questions measure the perceived benefits clients see of marriage following involvement of a healthy marriage program.  In particular, responses to these questions show whether clients, at program exit, value marriage as positive for children and something more valuable than just living together without marriage.  In FY 2017, 87.52 percent of the 11,494 adults who answered these questions on their exit survey expressed positive views toward marriage at program exit.  This proportion remained relatively stable in FY 2018 at 87.38 percent, but this represented a larger number of clients (15,596).  In FY 2019, 85.6 percent of the 17,908 adults who answered these questions expressed positive views at program exit, a decrease from FYs 2018 and 2017.  In FY 2021 and FY 2022, ACF aims to increase the proportion of participants who, at program exit, express positive attitudes toward marriage to 78 and 87 percent, respectively.

(For adult-serving programs) Increase the proportion of married couples who, at program exit, view their marriage as lifelong (Lead Agency – ACF; Measure ID – 22H)29

At program exit, adults in healthy marriage programs who are in relationships are asked the extent to which they agree or disagree with the following statement: "I view our marriage/relationship as lifelong."  This question measures whether clients, following involvement in a healthy marriage program, view their relationships as a lifelong commitment.  In FY 2017, 94.9 percent of 8,975 adult clients (in couple relationships) who answered this question on their exit survey viewed marriage as lifelong.  In FY 2018 this number was 94.2 percent, which again reflects a higher number of clients (11,829).  In FY 2019 this number was 94.7 percent, which reflects a higher number of clients (13,485) than answered the question in FYs 2017 and 2018.  In FY 2021 and FY 2022, ACF aims to reach a target of 85 percent and 95 percent, respectively, for the couples who, at program exit, view their marriage as lifelong.

(For youth-serving programs) Increase the proportion of youth who express attitudes supportive of the success sequence (Lead Agency – ACF; Measure ID – 22I)30,31

At program exit, youth in Healthy Marriage programs are asked the extent to which they agree or disagree with five statements "It is okay to live with a boyfriend/girlfriend without being married," "It is okay to live with a boyfriend/girlfriend without a plan to be married," "It is okay to have kids without being married," "It is okay to have kids without a plan to be married," and "It is hard on kids to be raised by a single parent."  These questions measure the perceived benefits of marriage and of adhering to the "success sequence,"32 following involvement in the youth-focused healthy marriage program.  Responses to these questions show whether youth view marriage as something positive for children and value marriage over other types of relationships.  In FY 2017, 61.33 percent of 8,026 youth clients who answered these questions on their exit survey expressed attitudes supportive of the success sequence.  In FY 2018, this rate was 65.15 percent of 8,617 youth clients who answered these questions, and in FY 2019 this rate was higher at 69.2 percent of 14,691 youth clients who answered these questions.  In FY 2021 and 2022, ACF aims to increase the proportion of youth who express positive attitudes toward relationships to 58.5 and 66 percent, respectively.

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26 The data for this performance goal are collected and reported every other year.

27 There was a delay in publication of CDC's NHANES data, and FY 2018 results will not be available until spring 2020.  CDC anticipates that subsequent NHANES data may also be delayed and has adjusted the reporting dates.

28 This is a new measure.  ACF is in the process of collecting data and determining targets.

29 This is a new measure.  ACF is in the process of collecting data and determining targets.

30 This is a new measure.  ACF is in the process of collecting data and determining targets.

31 To align with the school year, grantees serving youth clients in schools will likely stop offering services in the summer of 2020, several months before the end of the fiscal year in September.  Thus, the FY 2020 results might primarily reflect the attitudes of youth clients not served in schools.  This pattern also happened in FY 2016 and the percentage of youth who were supportive of the success sequence was much lower than other years (56.4 percent).  Therefore, ACF proposes a lower target, aligning with our proposed adjustments for COVID-19 in FY 2020.

32 The Millennial Success Sequence: Marriage, Kids, and the "Success Sequence" among Young Adults. 2017. Wang W. and Wilcox W.B. AEI/Institute for Family Studies.

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Content last reviewed September 27, 2022