Strengthening Early Childhood Systems: Lessons from the Pandemic and a Call to Action
For years, experts have called for a comprehensive system that links young children and families to needed health and social services at the community, state, and federal level. The coronavirus pandemic has revealed that the need for that system is more urgent than ever.
Children’s health and development is affected by a long list of social determinants, including safe housing, adequate nutrition, and access to health care and early education. “That’s why there are so many resources to support children and families, especially during the critical early years,” says NICHQ Project Director Loraine Swanson, MPH. “But without coordination between service providers, continuity in care is disrupted and families fall through the cracks. The coronavirus pandemic has exposed the dire consequences an uncoordinated system has on children and families when they are most in need.”
Because of COVID-19, key services such as well child visits, early intervention, and home visiting have been interrupted or drastically altered. At the same time, families are facing new stressors from social isolation, employment loss, and an unstable economy.
In response, health and social service providers have rushed to support families: child care services for essential workers, virtual home visits and telehealth support, food delivery services, financial support, and housing assistance programs have emerged, all of which can help families in need. But these services are only effective if families know about them, which is why a coordinated system is so important—always, but especially during a crisis. Without it, service providers can’t reliably know what supports exist in their communities and therefore, they cannot easily connect families with the resources they urgently need.
Vulnerable populations have disproportionately suffered from the lack of coordination across the system: Inequities stemming from poverty, racism, and bias have been intensified by the pandemic, making it even harder for people of color and families with lower income to access existing supports.
But even as these challenges have been amplified, states and communities have responded with innovative solutions that illustrate the great potential for transformative, accelerated systems change. Now, in the midst of this public health crisis, we—all those involved in systems-building—have an unprecedented opportunity to revisit the need for a coordinated early childhood system, intentionally outline and define what this system should look like, and identify and accelerate opportunities for improvement.
The argument for a stronger, more comprehensive early childhood system
Research from a life-course health perspective, the science of early development, and resilience and adversity is clear: the family, community, state, and policy context in which children develop have profound impacts on their life-long health and well-being. Research also shows that the best way to address the many factors influencing child development is through an integrated system—one with a coordinated network of health and social services, policies, and community leaders—that uses two-generation approaches to support the health of families holistically.
In other words, the connections between the services are the fabric of an effective and comprehensive early childhood system. Such a system would remove barriers for families, fully support their efforts in promoting their child's growth and development, and ultimately have a sustainable population level impact on early development and intergenerational well-being and opportunity.
Incredibly dedicated individuals are working at the federal, state, and local level to provide the many different services and supports families need. Yet often, funding, policies, resource flows, and administrative requirements don’t incentivize systems coordination and infrastructure building. And as a result, the fabric of the United States’ early childhood system remains weak.
What opportunities has the pandemic revealed?
To help families overcome new and existing barriers, service agencies are taking advantage of unprecedented flexibilities to transform their approach and move toward needed systems-change.
New flexibilities in program reporting requirements and service delivery mechanisms, adaptive philanthropy, a sense of urgency, and a clear need for collaboration and innovation on all levels point to the possibility of a comprehensive coordinated early childhood system. Strategies to dismantle seemingly fixed silos and create needed linkages between services carriers have emerged, laying the foundation for an envisioned system that promotes well-being for all.
The gaps and opportunities revealed by COVID-19 are a roadmap for developing a comprehensive early childhood system. This requires:
- Providing funding to coordinate state and community-level supports: Multiple, non-integrated funding streams that fund direct services but not collaboration among them have created gaps in the early childhood system. Because of these gaps, families miss out on needed services and supports. The pandemic has intensified this problem because families need those supports and services more urgently than ever. Fostering early childhood systems coordination at the state and community levels requires funding for collaboration and coordination. Specifically, this means funding direct service lines to allocate time and resources toward collaboration, and funding a backbone organization or program that can facilitate interaction between different service providers.
- Leverage two generation approaches: A child’s health and well-being is inextricably linked to the health and well-being of their parent or caregiver. Two-generation approaches that emphasize prevention and promote protective factors are critical to fostering child and family well-being. A comprehensive early childhood system should ensure that families have access to pediatric care, affordable childcare, and other early childhood support and services, as well as housing, job support, and education opportunities.
- Use intentional design to address system gaps: Successfully supporting two-generation approaches requires bridging gaps between the many different services that support families. Along with funding (see bullet 1), bridging these gaps depends on intentional design informed by all key stakeholders—health and social service providers, educators, state and local government officials, community leaders, and, perhaps most importantly, families who can best speak to the system gaps and inequities they experience.
- Put families first: At its core, a comprehensive early childhood system emphasizes the importance of valuing the role of families as first teachers, as care coordinators, and as long-term guardians for their children. With children home with their families and isolated from resources, the pandemic has shined a needed light on family’s incomparable role in promoting and protecting their children’s health. As such, the system’s primary focus should be on building the capacity of families and the communities in which they live, as this will ultimately increase opportunities for them to lead and succeed.
- Maintain adequate data: Adequate data means that service providers can easily identify who is at risk, know how to connect with them, and can track whether they receive services. This is always important, but especially during a pandemic when even more families are at risk. Being able to track and ensure linkages and referrals, the actual receipt of support and services, and the quality of linkages and access must be a core component of all local programs moving forward.
- Focus on equity: Providing universal and equitable access to concrete supports gives all families the freedom to choose services that work best for them, which is vital for promoting equity. All services should also be sensitive to unique cultural differences among families and communities, and service providers should be trained on cultural competency, cultural humility, and the importance of trauma-informed care.
Coordinated systems help states and communities better respond to the pandemic
NICHQ serves as the Coordinating Center for the Early Childhood Comprehensive Systems Collaborative Improvement and Innovation Network (ECCS CoIIN), a five-year initiative funded by the Health Resources and Services Administration Maternal and Child Health Bureau. NICHQ is working in partnership with 12 states and 28 place-based communities to achieve their goals of eliminating health disparities, enhancing early childhood systems building and coordination, and demonstrating improved outcomes in population-based children’s developmental health and family well-being.
Over the past four years, state and community grantees have made significant progress in developing a thoughtful and deliberate framework that strengthens the early childhood system of services for young children and their families. This framework has helped them coordinate responses during the pandemic, so that families can receive vital services.
For example, states with coordinated systems have been better able to leverage their 211 system, a local helpline that connects families with services and supports in their area. Because of coordination among service providers, states can make sure that their 211 resource specialists know exactly what’s available in their community and can then rapidly deliver services to families in need. Similarly, communities with coalitions of local services agencies have been able to respond quickly to the crisis, working with one another to identify who might be at risk in their community and developing an integrated process for connecting them with any services they might need.
Together, these bright spots illustrate the enormous potential of a coordinated early childhood system—one that engenders a culture of equity, quality, measurement, and accountability and ensures concrete supports for all families in times of need.
A Call to Action
The pandemic has provided an opportunity to consider what comes next when building broader systems of care. It has exposed system gaps, but it’s also ushered in unprecedented collaboration that has helped states and communities better support families.
“Let this be a call to action for all of us—early care and education programs, schools, communities, businesses, health and social service providers, public and private agencies, philanthropy, community and faith-based providers, and policymakers—to come together as system builders,” says Swanson. “It’s time to re-challenge ourselves to move out of our respected silos and bring our limited resources together to better examine gaps and build a truly responsive early childhood system.
“When we do this—when we come together as system builders, we can make changes necessary to assure the health and well-being of our nation’s youngest residents, now and in the future.”
NICHQ Employee Spotlight: Olivia Giordano
Olivia Giordano, MPH, Project Manager shares how her work with NICHQ’s Supporting Healthy Start Performance Project (SHSPP) is supporting 101 Healthy Start community sites to harness lessons learned, implement innovative approaches to improvement, and ultimately start to close the disparity gap in maternal and child health.
It Starts with Us and It Starts Now: Healing for Moms and Babies Begins with Ourselves and Our Systems
NICHQ CEO Scott D. Berns, MD, MPH, FAAP shares a message on healing and the ongoing need for equity-designed systems in 2021 and beyond.
Safe Sleep and Breastfeeding Initiative Invites Advocates to Join Communities of Practice
A multi-year initiative to improve infant safe sleep and breastfeeding is launching sector-specific Communities of Practice in 2021 to address policies, improve skills, and learn from other advocates’ experiences.
Top Equity Resources for Pursuing Change in 2021
Throughout this year, it has become clearer to many that the hard truth of the racism that shaped our nation requires us all—now, today—to acknowledge and address its impact in our health care systems and in ourselves. That's why we're sharing a collection of NICHQ articles and webinars that your community found most valuable in their equity journeys.
The Top Ten Children's Health Stories of 2020
In the final weeks of 2020, we’re looking back at our most popular articles of the year. From supporting children's health during the COVID-19 pandemic to pursuing equitable health systems, here’s a rundown of the top ten NICHQ articles you found most engaging over the past year.
Supporting the Whole Family: Fathers in Infant Health Outcomes
Cam, a father in Massachusetts, wants to lift the message that supporting the whole family is essential to child development. After becoming a father at 16, Cam connected to some community-based resources but says that more targeted efforts should be made available to fathers. Here, he shares a story that raises issues about fathers’ barriers to support and resources — and the impact of their engagement on child health outcomes.