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Collective Impact of Working Together for Children Florida Association for Infant Mental Health Orlando, FL April 24, 2014. David W. Willis, M.D., FAAP Director of the Division of Home Visiting and Early Childhood Systems (DHVECS) Maternal and Child Health Bureau

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Collective Impact of Working Together for ChildrenFlorida Association for Infant Mental HealthOrlando, FL April 24, 2014

David W. Willis, M.D., FAAP

Director of the Division of Home Visiting and Early Childhood Systems (DHVECS)

Maternal and Child Health Bureau

Health Resources and Services Administration

Department of Health and Human Services

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take home messages
Take Home Messages
  • The word is out that building health, school readiness and social well-being for the next generation of children requires embracing the one science of early brain and child development
  • Early childhood leaders must embrace a collective impact approach and integrate and coordinate all early childhood systems with evidence-based home visiting
  • Building on the learnings and innovations of place-based Initiatives provides breakthrough opportunities

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we re in the building health and developmental assurance business

We’re in the “building health and developmental assurance” business…

Physical health

Developmental health

Relational health

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drivers of developmental trajectories

Life Course

Drivers of Developmental Trajectories

Genetic, Prenatal and Neurodevelop-mental Factors

  • Neurodevelopmental
  • Social-economic
  • Relational

Social-economic environment

Attachment and Relational Patterns

(ACE Scores)

Relational Health

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an early brain and child development focus
An Early Brain and Child Development Focus
  • BUILDING HEALTH
    • Promoting the healthy early childhood foundations for life course health
    • Promoting relational health
    • Promoting kindergarten readiness
  • Mitigating toxic stress effects on health and developmental trajectories
  • Strengthening the systems and community supports to address the social determinants of health

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Population attributable risk

A large portion of many health, safety and prosperity conditions is attributable to Adverse Childhood Experience.

ACE reduction reliably predicts a decrease in all of these conditions simultaneously.

Source: Family Policy Council, 2012

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New Protective Interventions

Significant Adversity

Healthy Developmental Trajectory

Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

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Source: Harvard Center on Developing Child

strengthening families

Protective Factors Framework

Strengthening Families
  • Parental Resiliency
  • Social Connections
  • Knowledge of Parenting and Child Development
  • Concrete Support in Times of Need
  • Social and Emotional Competence of Children

Source: CSSP, 2012

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the home visiting program
The Home Visiting Program
  • In all 50 states, DC, and 5 territories
      • Formula grants based on child poverty
      • Competitive grants in 38 states
        • Development grants
        • Expansion grants
      • 3 Nonprofit Organizations in FL, ND, and WY
  • Tribal programs
      • 3 percent set-aside
      • 25 total grants

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home visiting program an evidence based place based strategy
Home Visiting ProgramAn evidence-based, place-based strategy
  • Programs 774 at-risk communities
  • Programs in 625 counties
  • 670,000 home visits in less 2 yrs. implementation
  • As of September 2013, states report serving ~ 80,000 parents and children

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d ata collection on benchmark areas
Data Collection on Benchmark Areas
  • Maternal and newborn health (8 constructs)
  • Child injuries; child abuse, neglect, or maltreatment; emergency department visits (7)
  • School readiness and achievement (9)
  • Crime (2) or domestic violence (3)
  • Family economic self-sufficiency (3)
  • Coordination/referrals for other community resources (5)

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moving from individual programs to integrated systems
Moving from Individual Programs to Integrated Systems

Source: Center for Study Social Policy 2013

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innovation lies at the intersection between e arly childhood systems and child health

Beyond social determinants of health…

“Innovation lies at the intersection between early childhood systems and child health”

Jack Shonkoff, M.D.

Harvard’s Center on the Developing Child

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e arly childhood comprehensive systems
Early Childhood Comprehensive Systems

Since its inception in 2003, ECCS has:

Forged new collaborations and partnerships.

Expanded policymakers’ awareness of pressing early childhood issues.

Viewed as the key resource in early childhood in states.

Supported materials and resource development.

Developed effective strategies to engage parents and families.

Established innovative financing structures for early childhood systems.

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Life expectancy and disability-free life expectancy at birth

by neighbourhood income deprivation, 1999-2003

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Source: Office for National Statistics, UK

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Differential Universality

On average, disadvantaged children (neighborhoods) have poorer outcomes. However, most vulnerable children are in the populous middle class.

Socioeconomic

Disadvantage

Socioeconomic

Advantage

Source: C.Hertzman, 2010

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Our Youngest Are Our Most in Need

Poverty/Income Level by Age Group

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Source: United States Census, 2010 American Community Survey

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Our Most Diverse Youngest Are Our Most in Need

Poverty/Income Level by Race/Ethnicity: 0-5 Year Olds

Source: United States Census Bureau, 2009-2011 Public Use Microdata Sample

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gaps in school readiness at 3 and 5 years by family income uk
Gaps in school readiness at 3 and 5 years by family income: UK

Average percentile score

Source: Waldfogel& Washbrook 2008

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social capital and inequality
Social Capital and Inequality
  • Unequal social capital contributes to unequal child development
  • Among U.S. Latinos, social capital within family networks is high, but parent-school social capital is low
  • Building family-school social capital may enhance child outcomes particularly for Latinos – the focus of our empirical analysis

Source: A. Gamoran, et al, 2012

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social capital
Social Capital

DEFINITION: The networks of relationships among people who live and work in a particular society, enabling that society to function effectively.

  • Viewed as the source of many positive outcomes
  • More than an individual asset
  • Also a feature of communities and nations
  • Degree of cohesiveness, connections
  • Decline of social capital is seen as responsible for many social ills

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social capital1
Social Capital
  • Relations of trust, mutual expectations, and shared values embedded in social networks
  • Not possessed by individuals, but rather a structure between and among individuals
  • Resides in the relationships individuals have with one another
  • Individuals can draw upon social capital in their networks
  • Social capital facilitates the flow of information and the development and enforcement of norms

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social capital in early childhood
Social Capital in Early Childhood
  • For young children, social capital operates through their parents
  • Two primary mechanisms
    • Social support
      • Parents who feel more connected to others have better access to information and are better able to establish and enforce norms with their children
    • Social control
      • Parents’ positive social networks offer collective socialization of children

Source: A. Gamoran, et al, 2012

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social network analysis
Social Network Analysis

“Set of methods and tools used to dynamically assess the growth of value derived by social interactions”

Peter Gloor, et al, 2013

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data to connect communities
Data to Connect Communities

Source: harder+company, First 5 Monterey County, 2012

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promoting social networks
Promoting Social Networks
  • For mothers and babies
  • For families
  • For neighborhoods
  • For communities
  • For programs and stakeholders

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home visiting program innovations
Home Visiting Program Innovations
  • Collaborations and integration across health and early learning
  • Integrating infant mental health competencies and reflective supervision
  • Core competencies across models and HV networks
  • “Crossing the data divide”
  • Population management
    • Universal intake and assessment systems
  • Father engagement in Home Visiting
  • Early Childhood Public-Private partnerships
  • Collective Impact

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collaborations across early childhood systems
Collaborations across Early Childhood Systems
  • ECCS (Early Childhood Comprehensive Systems)
  • Help Me Grow
  • Project LAUNCH (SAMHSA)
  • Child Welfare and Trauma-informed systems
  • Part C, IDEA
  • AAP Building Bridges Among Health and Early Childhood Communities
  • Race to the Top - ELC States
  • TECCS (Transforming Early Childhood Community Systems)
  • Place- Based Initiatives

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comprehensive integrated early childhood systems
Source: Amy Fine, 2014

Key Building Blocks

Focus on population and place

Whole child, family, community approach

Universal and targeted services /supports

Capacity building

Community change strategies

Comprehensive, Integrated Early Childhood Systems

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Work to align and integrate multiple sectors and systems.

Identify shared results to drive change and improve outcomes.

Analyze data to inform continuous improvements and innovations.

Grounded in supporting the importance and role of families.

Use intentional developmental activities to increase parental skills /capacities and build full range of child protective factors.

Strengthen social networks, a sense of community, & opportunities for leadership and collective action among residents.

Shared Strategies and Values of Effective EC Systems

Source: Early Childhood–LINC

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early childhood linc
Early Childhood - LINC

Source: Center for the Study of Social Policy, 2012

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collaboratives in the early literacy and language communities
Collaboratives in the early literacy and language communities

Campaign for Grade Level Reading

Help Me Grow

Reach Out and Read

Zero to Three

MIECHV, ECCS

LAUNCH / SAMHSA

Head Start / Child Care

RTT-ELC

BUILD

National League of Cities

  • Institute of Museums, Libraries Services (IMLS)
  • First Books
  • Corporation for National Community Service (CNCS)
  • Too Small to Fail
  • Clinton Global Initiative (CGI)
  • Bezos Family Foundation
  • Mind in the Making
  • ASCEND
  • 30 Million Word Initiative

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the five conditions of collective impact success
The Five Conditions ofCollective Impact Success
  • Common agenda – shared vision
  • Shared Measurement – collecting data and measuring results consistently
  • Mutually Reinforcing Activities – differentiating while still coordinated
  • Continuous Communication – consistent and open communication
  • Backbone Organization – for the entire initiative and coordinate participating organizations and entities

Source: J. Kania and M. Kramer, 2011

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transforming early childhood community systems teccs
Transforming Early ChildhoodCommunity Systems (TECCS)
  • Enhance the capacity of communities to improve early childhood development by
    • Establishing a community level indicator of children’s developmental outcomes using the Early Development Instrument (EDI)
    • Linking EDI data to local planning and improvement activities
  • Four Key Strategies
    • Community Engagement
    • Measurement, metrics, and analytics
    • Targeted system improvement
    • Collaborative learning networks

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australian early childhood index aedi
Australian Early Childhood Index (AEDI)
  • A population based measure which provides information about children’s health and wellbeing
  • 104 questions covering 5 development domains considered important for success at school
  • Teachers complete the AEDI online for each child in their first year of full-time schooling
  • Results are provided at the postcode, suburb or school level and not interpreted for individual analysis

Source: F. Oberklaid, 2014

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aedi national rollout 2009
AEDI National Rollout 2009
  • Number of communities 660
  • Number of schools 7,423
  • % of schools completed 95.6%
  • Number of teachers 15,528
  • Number of students 261,203
  • % of students completed 97.9%

Source: F. Oberklaid, 2014

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AEDI National Rollout 2012

  • Number of schools 7,147
  • % of schools completed 95.6%
  • Number of teachers 16,425
  • Number of students 289,973
  • % of students completed 96.5%

Source: F. Oberklaid, 2014

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percentage of children developmentally vulnerable dv across australia by jurisdiction

Key Findings - 2009

Percentage of children developmentally vulnerable (DV) across Australia by jurisdiction

Source: F. Oberklaid, 2014

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results socio economic status
Results: Socio-economic status

Source: F. Oberklaid, 2014

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breakthrough opportunities
Breakthrough Opportunities
  • Health Reform and the Triple AIM
  • Monitoring and Managing Adverse Childhood Risk
  • Information technology / unified and longitudinal data sets
  • Business sector engagement
    • ReadyNation – ROI, workforce development
    • Too Small to Fail Initiative – Clinton Global Initiative
  • Early education readiness is a health outcome
  • Building an “early learning nation”

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a roadmap forward
A “roadmap” forward
  • Document problems and needs
  • Develop data base
  • Mapping of existing services
  • Involve community leaders to improve coordination and evolve services
  • Local community ownership – tight/loose control
  • Focus on outcomes, not processes
  • Focus on children and families, not programs

Source: F. Oberklaid, 2014

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the road to reform
The road to reform
  • Data and information – epidemiology of need, demographics, services mapping, resources and assets, workforce
  • Local partnerships of all stakeholders
  • Strategy – develop a local plan
  • Reform service delivery – evidence, focus on outcomes, integrated services
  • Change in practice – major (re)training agenda
  • Build capacity – sustainability
  • Monitor, evaluate, review and reform

Source: F. Oberklaid, 2014

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coming together is a beginning staying together is progress and working together is a success

“Coming together is a beginning, staying together is progress, and working together is a success”

Henry Ford

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the beginning of partnerships
The beginning of partnerships
  • Start anywhere, start small
  • Not rocket science
  • All about (respectful) relationships
  • Mapping community services and resources
  • Universal services – “soft entry points” into system
  • Formal structures follow informal networks
  • Intent and commitment more critical than money and resources
  • There are no “they” – everyone is a leader
  • Takes time: patience and persistence are virtues

Source: F. Oberklaid, 2014

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it s all about
It’s all about:
  • Building health, First 1000 Days
  • “Building brains, forging futures!”
  • The earliest relationships and their sturdiness
  • Breaking the generational transmission of abuse, ACE transmission and toxic stress mitigation
  • Partnerships and shared values of communities of all

agencies that becomes a collective impact approach

  • A culture of quality, measurement and accountability
  • All children, population approaches, place-based strategies
  • Driving innovation and awakening new leadership
  • Proven, wise and sustainable investments for young

children’s future

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take home messages1
Take Home Messages
  • The word is out that building health, school readiness and social well-being for the next generation of children requires embracing the one science of early brain and child development
  • Early childhood leaders must embrace a collective impact approach and integrate and coordinate all early childhood systems with evidence-based home visiting
  • Building on the learnings and innovations of place-based Initiatives provides breakthrough opportunities

56

contact information
Contact Information

David W. Willis, MD, FAAP

Director, Division of Home Visiting

and Early Childhood Systems

Maternal and Child Health Bureau, HRSA

301-443-8590

[email protected]

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