1. 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

2. 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

3. 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

4. Together We are Stronger than the Sum of Our Parts4

5. We’re in the “building health and developmental assurance” business…
Physical health
Developmental health
Relational health 5 5

6. 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

7. 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

8. 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

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

10. 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

11. Relational Health 11 11

12. 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

13. 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

14. 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

15. 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

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

17. 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

18. 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

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

20. 20

21. 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

22. Our Youngest Are Our Most in Need Poverty/Income Level by Age Group22
Source: United States Census, 2010 American Community Survey

23. Our Most Diverse Youngest Are Our Most in Need
Poverty/Income Level by Race/Ethnicity: 0-5 Year Olds
Source: United States Census Bureau, Public Use Microdata Sample 23

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. Promoting Social Networks
For mothers and babies
For families
For neighborhoods
For communities
For programs and stakeholders 31

32. Together We are Stronger than the Sum of Our Parts32

33. 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

34. 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

35. 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

36. 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

37. Early Childhood - LINC
Which service sectors are actively engaged in the initiative? (Select all that apply.)
N= 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

38. 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

39. 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

40. 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

41. 41

42. 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

43. % 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

44. % 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

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

46. 46

47. Source: F. Oberklaid, 2014 47

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

49. 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

50. 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

51. 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

52. “Coming together is a beginning, staying together is progress, and working together is a success”
Henry Ford 52

53. 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

54. “Nothing hard is ever easy”
Don Berwick 54

55. 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

56. 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

57. Contact Information
David W. Willis, MD, FAAP
Director, Division of Home Visiting
and Early Childhood Systems
Maternal and Child Health Bureau, HRSA 57 57