Case Studies

Accelerating Action and Gaining Traction

From 2016 to 2021, with funding from the Health Resources & Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB). the National Institute for Children’s Health Quality (NICHQ) led the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN), a five-year effort (August 1, 2016 through July 31, 2021) to strengthen systems to improve population level early childhood developmental health and family well-being in 28 communities across 12 states. The aspirational aim of this program was to increase age-appropriate developmental skills among three-year-old children and reduce developmental disparities

An expanding body of scientific evidence points to the critical importance of early childhood experiences (prenatal through age three) in setting the foundations for lifelong health and well-being. At the same time, there is a growing awareness that an increasing proportion of young children and families are falling behind: that inequities related to race, place, and income for the youngest children and their families are all too common and too often translate into lifelong disadvantages in health, education, economic success, and general well-being. As a result, in communities and states across the country, there is a growing movement to develop coordinated, effective, and high-quality systems to support all parents and give all young children an optimal start. ECCS CoIIN is one of these systems-building initiatives. 

 ECCS CoIIN produced case studies on the following topic areas: 

  • Applying a System Maturity Framework to Understand Progress and Success

  • Engage and Empower Families at all Levels of Leadership

  • Enhancing and Developing Community Platforms to Promote the Developmental Health of Young Children

  • Improving Systems Performance Measurement

  • Policies to Solidify, Institutionalize, and Formalize Advancements for Sustainability

  • States and Communities Working Together: Partnerships for Impact

Applying a System Maturity Framework to Understand Progress and Success
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Applying a System Maturity Framework to Understand Progress and Success

As ECCS CoIIN system building leaders worked together with their partners to embrace a collective impact framework, develop a vision, articulate shared goals and activities, and identify indicators of progress, there was a growing recognition that a developmental framework of systems building work is needed to articulate the nuances of each state’s system building activities, successes, and challenges. Each state and community began this work in different starting points and progressed at varying paces. One state’s or community’s success may have been very different than another State’s or community’s success depending on their starting point. Understanding and comparing their progress requires a deep awareness of their starting point and progression or their system’s “maturity”.

Engage and Empower Families at all Levels of Leadership
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Engage and Empower Families at all Levels of Leadership

“Nothing about us without us”1 is a refrain used to communicate the importance of involving the representatives from the populations served when making decisions about the programs and policies supporting them. For early childhood systems-building, these representatives are families from the communities who are raising young children or grandchildren and who will be impacted by decisions made. Supporting these families to be leaders can happen at many levels, ranging from an individual provider and family 1:1 relationship to many providers collaborating to build capacity of families and empowering them to influence the collective system. This brief highlights the latter through presenting successful strategies in three of the ECCS CoIIN states and their place-based communities, including Florida, Massachusetts, and New Jersey.

Enhancing and Developing Community Platforms to Promote the Developmental Health of Young Children

Enhancing and Developing Community Platforms to Promote the Developmental Health of Young Children
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The research is clear: Equipping parents with the appropriate tools and knowledge to understand development and advocate for their children’s developmental health is essential to promoting optimal well-being of children. Yet, the
current system of health and support services too often expects families to know developmental milestones and understand how to navigate the services from which they and their children may benefit. To successfully reach families
in the community to share developmental health information and the availability of services that support development, it is important to provide accessible ways for them to engage or participate. The ECCS CoIIN community teams successfully implemented innovative ways to reach families who might not have otherwise been contacted. This brief presents different community platforms, defined as vehicles created and driven by the ECCS CoIIN community teams that allow for creating and maintaining connections toward a common goal of promoting optimal development of young children.

Improving Systems Performance Measurement

Improving Systems Performance Measurement
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The ECCS CoIIN was created to accelerate early childhood system building, bring continuous quality improvement methodology to the field, and advance population-based measurement of child well-being. ECCS CoIIN funded states utilized a collective impact framework and continuous quality improvement methodologies to support both ECCS CoIIN state and community teams in achieving the overall goal of the ECCS project to improve population-level outcomes in children’s developmental health and family well-being indicators. The global aim, as conceived from project inception, stated that ECCS CoIIN participants would show a 25 percent increase from baseline in age-appropriate developmental skills of their communities’ three-year-old children. Measurement was a key component of cataloging success and improvement within ECCS improvement and sustainability; however, quantifying and measuring systems-level change was an area that ECCS CoIIN participants found particularly challenging. This case study highlights the challenges around measuring systems-level change experienced by early childhood system building leaders, summarizes the rationale behind ECCS CoIIN’s approach to system performance measurement, provides two examples illustrating a range of approaches to measurement by communities, and describes the ECCS-specific alignment opportunity that led to the development of two new measures and refinement of two other measures.

Policies to Solidify, Institutionalize, and Formalize Advancements for Sustainability

Policies to Solidify, Institutionalize, and Formalize Advancements for Sustainability
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The Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN) Impact Grantees (IGs) and Place-Based Communities (PBCs) implemented several successful activities and strategies at both the state and community levels that they wanted to sustain beyond the life of the grant, such as improving developmental screening in various settings (e.g., early childhood education settings, family engagement and leadership; integrated data systems; establishment of a permanent early childhood council; and increased participation in council meetings). One of the original secondary aims of the ECCS CoIIN was to test innovative Early Childhood systems change ideas, develop spread strategies, and adopt new Early Childhood policies for sustaining the systems developed during this project that improve children’s developmental health and family well-being. This aim was updated with the development of the ECCS Logic Model under Policy Transformation: to include policy development and improvement are key to support, accelerate, and sustain an early childhood system. This brief describes successful approaches the ECCS CoIIN IGs and PBCs employed to advance policies and mobilize funding to sustain system improvements. It also includes three state-level policy examples of how they sustained various efforts of the ECCS CoIIN work within their states.

States and Communities Working Together: Partnerships for Impact

States and Communities Working Together: Partnerships for Impact
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An expanding body of scientific evidence points to the critical importance of early childhood (prenatal through age three) experiences in setting the foundations for lifelong health and well-being. At the same time, there is a growing awareness that an increasing proportion of young children and families are falling behind: that inequities related to race, place and income for the youngest children and their families are all too common and too often translate into lifelong disadvantages in health, education, economic success, and general well-being. As a result, in communities and states across the country, there is a growing movement to develop coordinated, effective, and high-quality systems to support all parents and give all young children an optimal start. ECCS CoIIN is one of these systems building initiatives. The systems that serve children and families at all levels tend to be complicated to navigate; therefore, coordination is needed to reduce duplication of effort, enhance continuity of care, track outcomes across systems, and maximize fiscal and staff resources. The ongoing development of a strong state and local connection is key to the continuous improvement of the early childhood system.