Healthy Relationships, Healthy Children Building a Baby Bundle

Healthy Relationships, Healthy Children: Building a Baby Bundle Champions for Young Children Workshop August 3, 2018 Janice Gruendel, Ph.D., M.Ed. Senior Fellow, Institute for Child Success janice.gruendel@aya.yale.edu

Our work for today Setting the SC context Remembering the neuroscience What’s in your backpack? Building a Baby Bundle Why we do this work…

# 38 Part I Setting the SC Context

The bottom line: We have some more work to do… A FEW FAST FACTS 41% of all children live in single parent families 55% of children under age six live in low-income families (200% of FPL or less) 22% of South Carolina adults have reported two or more ACEs 22% (or more) young children have experienced at least three risk factors The bottom line: We have some more work to do…

Part II Remembering the neuroscience

All families face some adversities, and some families face more… Maternal depression Parent-child attachment Domestic violence Substance Abuse ACES Parental Health & Mental Health Child Health, MH and Behavior Family Basic Needs Unstable/unsafe housing Family and community violence Not enough food to get through the month Unstable child care Weak social networks & social capital Unstable work status Needs of aging parents Developmental delays Health problems Social-emotional issues Anxiety/fear/aggression Program absences School suspensions/ expulsions School performance Adapted from ACF: 10.14.17

When Stress Becomes Toxic NORMAL STRESS Getting immunized; Meeting new people; First day at school. First day at work. Presenting big ideas at a public meeting; Performance evaluation Key Concepts: Toxic Stress. Harvard Center on the Developing Child, Retrieved July 2015 TOLERABLE STRESS Serious Illness; Death of a loved one; Frightening accident; Acrimonious divorce; Persistent discrimination TOXIC STRESS Tolerable stress that is NOT buffered by caring, actively-present adults (or peers). The body’s stress system activates and stays at high levels “like revving a car’s engine for hours every day.” This causes damage at the cellular level of our bodies, impacts our health and mental health, and can be passed from one generation to the next at the genomic level.

The Arc of Science: Gruendel 12.5.17 Remember, adversity in the lives of young children can have dramatic consequences that can last a lifetime The early years really matter Intertwined cognitive and social- emotional development Executive function Self –regulation Empathy Trauma Toxic Stress Adverse Childhood Experiences Poverty Racism & Implicit Bias Inequity and Instability Politics… Mindfulness Health Hope Healing Resilience We could spend an hour or a day on this slide. It is the platform on which we have build our bundle and with which we ALWAYS start. I won’t spend an hour but I hope we can come around again together and unpack it fully and richly, and learn how to use it across audiences. I will make just four quick points. The first and last items reflect our developmental goals : Normal and normative brain development, and both internal and external states of wellness. Remember that cognitive and social-emotional development are intertwined, experience explosive growth as the brain grown in the first years, and that while both executive function and self-regulation (managing ourselves in our world) begin to develop early but don’t burst forward until the later teen and early adult years. J JUST TALK THE OTHERS WE CAN BUILD IT The Arc of Science: Gruendel 12.5.17

Parents and Babies: Moms matter and dads matter, too CLICK NOW The Still Face Experiments

Part III What’s in Your Backpack?

Remembering the ACES story CLICK NOW

HANDOUT ACES Yes or No. Count up the total 1. Did a parent or other adult in the household often swear at you, insult you, put you down or humiliate you, or act in a way that made you afraid that might be physically hurt? 2. Did a parent or other adult in the household often push, grab, slap or throw something at you, or ever hit you so hard that had marks or were injured? 3. Did an adult or person at least 5 years old than you ever touch or fondle you or have you touch their body in a sexual way, or try to actually have oral, anal or vaginal sex with you? 4. Did you often feel that no one in your family loved you or thought you were important or special, or your family didn’t look out for each other, feel close to each other, or support each other? 5. Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you, or your parents were too drunk or high to take of you or take you to the doctor if you needed it. 6. Were your parents ever separated or divorced? 7. Was your mother or stepmother often pushed, grabbed, slapped or had something thrown at her, or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard, or Ever repeatedly hit over at least a few minutes or threatened with a gun? 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? 9. Was a household member depressed or mentally ill or did a household member attempt suicide? 10. Did a household member go to prison?

RESILIENCE Questionnaire Yes Maybe No HANDOUT 1. I believe that my mother loved me when I was little. 2. I believe that my father loved me when I was little. 3. When I was little, other people helped my mother and father take care of me; they seemed to love me. 4. I’ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too. 5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried. 6. When I was a child, neighbors or my friends’ parents seemed to like me. 7. When I was a child, teachers, coaches, youth leaders or ministers were there to help me. 8. Someone in my family cared about how I was doing in school. 9. My family, neighbors and friends talked often about making our lives better. 10. We had rules in our house and were expected to keep them. 11. When I felt really bad, I could almost always find someone I trusted to talk to. 12. As a youth, people noticed that I was capable and could get things done. 13. I was independent and a go-getter. 14. I believed that life is what you make it.

About Me HANDOUT My Aces Score My Resilience Score My current challenges My strengths and supports today My school climate My classroom climate

What do I know? What can I know? How can I know it? Early Trauma Early Resilience Current Challenges Current Strengths My classroom learning climate My classroom behavior climate HANDOUT About the kids my classroom What do I know? What can I know? How can I know it?

So, what about the babies? Part IV Building a Baby Bundle So, what about the babies?

A Case Example: Bridgeport, Connecticut City population: Nearly 146,000 Annual Births: About 1800 99.9% Free and Reduced Lunch Bridgeport is surrounded by the wealthiest cities/towns in the state and the nation, and has the largest achievement/opportunity gaps in America.

A Case Example: Spartanburg, South Carolina City population: Just over 37,000 Children under 5: About 1350 Children to age 28 in poverty: 26%

The Bridgeport Story 14% of 8th graders proficient in math 30% of 3rd graders reading at level 30% of entering K school ready 75% of three-year olds enter Head Start BEHIND 15% no or inadequate prenatal care 2/3rds of the city’s 1800-2000 births are Medicaid funded In Bridgeport’s collective impact effort, we started with the data…

Our BHAG: Born Healthy and Ready at 3 All Bridgeport babies born beginning in January 2018 will reach expected health and developmental benchmarks by the age of three.

Strong & Healthy Families Strong & Healthy Schools & Communities Healthy Babies and Toddlers Strong & Healthy Schools & Communities The science says: To raise kids who are healthy and ready at 3 we need to build ‘relational health’ by investing in… RESILIENCE

An Organizational Reality Check: Real-time Data on Clients & Outcomes CQI and Accountability Resource Flexibility & Innovation Internal & Cross-Agency Workforce Support & Development Strategic Planning, Policy & Communication Strategic Partnerships An Organizational Reality Check: Do we have a 21st century management and operational system at the city and state level? Finally, we live in a rapidly changing 21st century world of operational systems and we cannot build our new goals on the basis of yellow pads and pencils. There is a lot of incredibly hard work to do here, but we believe that America’s heath and human services is ready for the challenge and moving to build 21st century systems and operations We talk about 6 components but there are many ways to depict operational improvement. Data is at the center. Resource flexibility is key. Quality improvement. Workforce development, and Strategic planning and strategic communications round out our operations bundle.

The Bridgeport Baby Bundle Design Supported Care and Parenting An Army of Helpers and Advocates Bridgeport Baby Investment Bundle Innovation and Better Connections Track Change. Measure Impact OK. This is the Bridgeport Baby Bundle as I shared it with you a couple of weeks ago. I promised to go more deeply into each strategy BUT Today let’s look specifically at the Baby Investment Bundle. IF I were to summarize the whole Baby Bindle diesing, tho, I would would say it starts with parents and families, invites a civic and social movement behind them, makes financial investments, promote both innovation and evidence-based program and practice expansions, formalizes and celebrates partnership, and honestly tracks change and measure impact., and shares that information. The graphic is beautiful, clever and we can say going up the elevator with some CEO or legislator. You know, the 45 second rule!!!

A Peek at What’s Inside Each Strategy Blue & bold=action An Army of Helpers and Advocates The Baby Investment Bundle Innovation and Better Connections Track Change. Measure Impact Supported Care and Parenting The Bridgeport Basics Pre- and perinatal universal home visiting Universal screening Early literacy Infant and toddler family child care Maternal wellness (including MH) Resilience screenings The Bridgeport “Baby Squad” Building champions: Faith, pediatric, higher education and giving Sectors Strategy #1 PLUS Strategy #5: Innovative Funding re Data; High wealth donor Baby Scholarships; State Medicaid re-form funding Authentic Family & Neighborhood Engagement Elders Rock the Babies Top to Bottom (linking food & diapers) Respectful service access: No wrong door and a warm handoff National Interoperability Collaborative Bpt Virtual Baby Data Coalition: DSS, OEC & SDE Partnership City DPH and hospital data Medicaid admin data

A Deeper Dive on Strategy #1 Innovation and Better Connections Supported Care and Parenting The Bridgeport Basics: Customized free website with videos and other materials Pre- and perinatal universal home visiting: Expand Family Connects Universal screening: New APP for parents (Sparkler with Ages and Stages), Expand pediatric developmental screening and data sharing Early literacy: Expanding Reach Out and Read, and linking with Read to Grow Infant and toddler family child care: All Our Kin Maternal wellness (including MH): Expand ACES and maternal depression screening and the MOMs Partnership The Bridgeport Basics Pre- and perinatal universal home visiting Universal screening Early literacy Infant and toddler family child care Maternal wellness (including MH)

A Sample of a Deeper Dive on Strategy #1 Innovation and Better Connections 1. Supported Care and Parenting: Cross-Strategy Linkages The Bridgeport Basics Pre- and perinatal universal home visiting Universal screening Early literacy Infant and toddler family child care Maternal wellness (including MH) 2. An Army of Helpers and Advocates Community hosted Resilience screenings 3. Baby Investment Bundle Sponsors being sought for ongoing Basics’ website costs and new pediatric channel (below) 4. Innovation and Better Connections Basics’ videos on new pediatric office TV channel and in social services offices and well-child clinics

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Hello Family: The Spartanburg Bundle Hello Family seeks to improve outcomes for Spartanburg’s young children prenatally through age five (and their families) through a Pay for Success social financing strategy.

The Spartanburg Pay for Success Story A Pay for Success project drives better outcomes by paying for positive, measurable outcomes once they are achieved – as opposed to paying for services upfront regardless of outcomes achieved. Some people also call this Pay for Performance. ICS, May 2, 2018

Approximate Service Population Potential Outcome Metrics HELLO FAMILY PROGRAM PRENATAL - BIRTH BIRTH – 6 MONTHS 6 MONTHS – 5 YEARS BIRTH – 6 MONTHS Revised: May 2, 2018 IMPACTS BirthMatters Family Connects Triple P Quality Counts REDUCED: Service Provider Doula support for low-income mothers Universal postnatal nurse home visiting Universal parenting and family support Early Learning Quality Improvement Child medical costs Parent medical costs Child Protective Services costs Mental health costs Substance abuse Criminal behavior Remedial education costs Approximate Service Population 350 1,500 2,100 820 Spartanburg, SC IMPROVED: REDUCE: Low-weight births Preterm births Caesarean birth rate NICU admissions INCREASE: Breastfeeding at birth Healthy birth spacing REDUCE: Emergency medical utilization, ER and inpatient. INCREASE: Access to high quality childcare REDUCE: Foster care placements Child maltreatment INCREASE: Tentative: Family Protective Factors REDUCE: Teacher turnover INCREASE: Kindergarten Readiness Classroom quality Teacher qualifications and retention Child and adolescent behavior Cognitive development Educational outcomes Labor market outcomes Potential Outcome Metrics

This is a lot of stuff to think about WHEW… This is a lot of stuff to think about

But now that we know… Health, hope, kindness and resilience are ours to build, together for our children and ourselves Just one word on this slide. We have been searching around for the one image that conveys who we are, what we value and where we are going. This is the image. For us, it speaks legions to our humanity, and to our belief our strength comes from holding each other close.

A Final Thought…