Collective Impact of Working Together for Children
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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 Children Florida Association for Infant Mental Health Orlando, FL April 24, 2014

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Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

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

1


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

2


A league table of child well being

A League Table of Child Well-Being

Source: UNICEF, 2013

3

3


Together we are stronger than the sum of our parts

Together We are Stronger than the Sum of Our Parts

4


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

5

5


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

6

6


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

7

7


Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

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

8


Down stream health problems related to early life

Down stream health problems related to early life

Source: B. Perry 2013

9


Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

New Protective Interventions

Significant Adversity

Healthy Developmental Trajectory

Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments

10

Source: Harvard Center on Developing Child


Relational health

Relational Health

11

11


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

12


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

  • 13


    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

    14


    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)

    15


    Moving from individual programs to integrated systems

    Moving from Individual Programs to Integrated Systems

    Source: Center for Study Social Policy 2013

    16


    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

    17

    17


    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.

    18


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    Life expectancy and disability-free life expectancy at birth

    by neighbourhood income deprivation, 1999-2003

    19

    Source: Office for National Statistics, UK


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    20


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    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

    21


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    Our Youngest Are Our Most in Need

    Poverty/Income Level by Age Group

    22

    Source: United States Census, 2010 American Community Survey


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    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

    23


    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

    24


    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

    25


    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

    26


    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

    27


    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

    28


    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

    29


    Data to connect communities

    Data to Connect Communities

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

    30


    Promoting social networks

    Promoting Social Networks

    • For mothers and babies

    • For families

    • For neighborhoods

    • For communities

    • For programs and stakeholders

    31


    Together we are stronger than the sum of our parts1

    Together We are Stronger than the Sum of Our Parts

    32


    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

    33

    33


    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

    34

    34


    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

    35


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    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

    36


    Early childhood linc

    Early Childhood - LINC

    Source: Center for the Study of Social Policy, 2012

    37


    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

    38


    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

    39


    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

    40


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    41


    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

    42


    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

    43


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    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

    44


    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

    45


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    46


    Collective impact of working together for children florida association for infant mental health orlando fl april 24 2014

    Source: F. Oberklaid, 2014

    47


    Results socio economic status

    Results: Socio-economic status

    Source: F. Oberklaid, 2014

    48


    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”

    49


    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

    50


    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

    51


    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

    52


    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

    53


    Nothing hard is ever easy

    “Nothing hard is ever easy”

    Don Berwick

    54


    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

    55


    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]

    57

    57


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