Collective Impact of Working Together for Children Florida Association for Infant Mental Health Orlando, FL April 24, 2014 Good morning, thank you for such a kind introduction. I’m just delighted to be with you this morning. I bring you greetings from: Dr. Mary Wakefield, HRSA Administrator and Dr. Michael Lu, Associate Administrator for Maternal and Child Health. I am excited about Dr. Lu’s leadership and his articulated “New Vision for MCHB” – first and foremost, he wants to put the “M” back in MCHB and he says that “We are going to improve maternal and child health in our nation by improving access, quality, integration, accountability and equity.” And, amazingly, one of MCHB’s signature programs is our MIECHV – Maternal, Infant and Early Childhood Home Visiting, now three years old. We know that this one of the most significant investments to improve the health, safety and parenting abilities of poor mothers and their infants in my lifetime! And now that the President’s second-term agenda is to continue to build out the birth to three investments, including expansions of MIECHV, it is the most exciting time I’ve seen in our field in our lifetime. Our time has come! Our call is clear! And as Dr. Lu says, “Failure is not an option! 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 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 “The true measure of a nation’s standing is how well it attends to its children – their health and safety, their material security, their education and socialization, and their sense of being loved, valued and included in the families and societies into which they are born” UNICEF Innocenti Research Center 2013 Source: UNICEF, 2013 3 3

Together We are Stronger than the Sum of Our Parts 4

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 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

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 8

Down stream health problems related to early life Source: B. Perry 2013 9

Healthy Developmental Trajectory New Protective Interventions Significant Adversity Healthy Developmental Trajectory Supportive Relationships, Stimulating Experiences, and Health-Promoting Environments Source: Harvard Center on Developing Child 10

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 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 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

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) Grantees must report on all families, all constructs 35, and all benchmarks. 15

Moving from Individual Programs to Integrated Systems Source: Center for Study Social Policy 2013 16

Jack Shonkoff, M.D. Harvard’s Center on the Developing Child 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

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

Life expectancy and disability-free life expectancy at birth by neighbourhood income deprivation, 1999-2003 Source: Office for National Statistics, UK 19

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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 21

Our Youngest Are Our Most in Need Poverty/Income Level by Age Group 22 Source: United States Census, 2010 American Community Survey

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 Average percentile score Fig 2.22 Source: Waldfogel & Washbrook 2008 24 24

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 Viewed as the source of many positive outcomes 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 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 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 “Set of methods and tools used to dynamically assess the growth of value derived by social interactions” Peter Gloor, et al, 2013 Collects data on who is connected to whom How those connections vary and change Focus on patterns of relations Distinct from the methods of traditional statistics and data analysis…theories, models, and applications are expressed in terms of relational concepts or processes. 29

Data to Connect Communities Plenty of research has shown that tight bonds among a community of service providers leads to: knowledge-sharing, efficient use of community resources, and ultimately better access to the services that people need First 5 Monterey evaluation to look at two key questions: What is the nature of the relationships among funded partners, and to what extent are these agencies collaborating with each other? How do funded partners perceive their interactions with each other? Source: harder+company, First 5 Monterey County, 2012 30

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 Parts 32

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 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 Key Building Blocks Focus on population and place Whole child, family, community approach Universal and targeted services /supports Capacity building Community change strategies Source: Amy Fine, 2014 35

Shared Strategies and Values of Effective EC Systems 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. Focus on both systems integration and systems change. Source: Early Childhood–LINC 36

Early Childhood - LINC Which service sectors are actively engaged in the initiative? (Select all that apply.) N=119 Percent Parenting Education 111 93% Child Care and Early Education 107 89% Family Support 106 88% Health 102 85% Mental Health /Infant Mental Health 98 82% K-12 Education 82 68% Child Welfare 78 65% Family Literacy 65 54% Higher Education 45 38% Workforce Development 43 36% Substance Abuse Treatment 33 28% Food Security 31 26% Economic/Community Planning and Development Housing 24 20% Law Enforcement 19 16% Legal services 9 8% You can see that most surveyed initiatives involve parenting education, child care and early education, family support, health and mental health/infant mental health. Our analysis shows that two-thirds said all five were actively part of their efforts. School systems are actively represented in two-thirds of the initiatives responding to the survey. Some community-based early childhood initiatives actively engage services and systems that can help achieve parents’ own life goals for education and employment – like family literacy, workforce development, higher education. Often called two generation strategies. We were excited to see this because we all know that research is very clear on the the linkages between parental well-being (particularly of mothers) and child well-being. Source: Center for the Study of Social Policy, 2012 37

Collaboratives in the early literacy and language communities 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 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 38

The Five Conditions of Collective 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) 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

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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

% of schools completed 95.6% Number of teachers 15,528 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

% of schools completed 95.6% Number of teachers 16,425 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

Key Findings - 2009 Percentage of children developmentally vulnerable (DV) across Australia by jurisdiction Source: F. Oberklaid, 2014 45

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Source: F. Oberklaid, 2014 47

Results: Socio-economic status Source: F. Oberklaid, 2014 48

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 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 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” Henry Ford 52

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” Don Berwick 54

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 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 David W. Willis, MD, FAAP Director, Division of Home Visiting and Early Childhood Systems Maternal and Child Health Bureau, HRSA 301-443-8590 dwillis@hrsa.gov 57 57