PolicyLab

PolicyLab’s research includes a focus on the systems and programs that support early childhood development. A notable challenge is that these systems are often fragmented and siloed, making it difficult for families to benefit fully and easily. 

To that end, PolicyLab has sought to identify and pilot integrated child- and family-serving programs that foster collaboration and improve communication for sharing of critical patient information. To inform these efforts, we recently conducted a literature review to compile approaches to address fragmentation and build collaboration across programs and systems that serve young children. We're interested in learning from what other states and municipalities across the U.S. have done to bring this to our work in Pennsylvania.

Below, we summarize key takeaways that we’ll use as we continue to explore this issue.

Map systems, programs and funding

Mapping helps describe current systems and available resources. While there are many different mapping approaches, these three have been successfully used in the child and family health space and present opportunities for public agency-research partnerships

• Journey mapping charts the experiences that users have navigating systems. Several years ago, Alaska sought “to better align Medicaid and early childhood services to improve maternal health and reduce infant out-of-home placement.” A cross-agency state team utilized journey mapping to gain insight into the experiences of pregnant people with substance use disorders to ultimately identify opportunities to align care and support through the different organizations and agencies.

• Fiscal mapping records funding streams available for kids and families. Children’s Funding Project, an organization that works with states and advocates on strategic financing options, has created publicly available fiscal maps reflecting investment in children for 17 states. These help government leaders and advocates understand the current funding landscape, allowing them to assess whether existing resources align with their goals for kids, coordinate service delivery across program areas, identify unmet needs and areas for innovation, and leverage new funding opportunities.

• Social network analysis (SNA) can be used to visualize organizational networks. SNA produces maps that show how organizations interact and relate to each other and the strength of those relationships. PolicyLab researchers and project partners recently used SNA to gain a baseline understanding of existing collaboration between social and clinical services available to families with young children impacted by intimate partner violence (IPV). Our findings revealed clear opportunities to strengthen the local maternal and child health system and laid the groundwork for an ongoing partnership with IPV agencies and early childhood home visiting programs. Broadly, SNA is a powerful tool to help communities and systems visualize complex relationships, allocate resources and drive strategic systems-change efforts.

Design structures for coordination

Many agencies, health systems, organizations, and advocates are working towards improving early childhood development for children and families. Establishing and leveraging structures that support collaboration and efficiency across these systems and services is a promising practice.

Some states have established interagency work groups, advisory councils, and comprehensive agencies comprised of a multidisciplinary membership to inform and in some cases operate as the decision-making bodies for early childhood programs and policies. For example:

• South Carolina’s First Steps program is a state agency that uses public and private funds for early childhood development programs. First Steps brings together all the early childhood agencies in South Carolina and manages an Early Childhood Advisory Council, which assembles representatives from government, health care, early childhood education, the business community and families.

• Children’s cabinets are groups of government leaders and community stakeholders that "break down silos across government agencies and/or service providers to improve outcomes for children and families.” As of 2020, more than 30 states and communities have some sort of children's cabinet.

A study is currently underway at the Prenatal-to-3 Policy Impact Center to shed light on how different models of early childhood system governance influence services.

Optimize coordination within and beyond health system walls in early childhood

Health care providers serving families in the early childhood period have a unique opportunity to connect patients and their families to appropriate resources and provide adequate support in navigating these services.

• New York City Health and Hospitals’ 3-2-1 IMPACT coordinates across three disciplines (women’s health, behavioral health and pediatrics) to address child and family needs. 3-2-1 IMPACT incorporates multiple evidence-based interventions within pediatric health care (HealthySteps, Reach Out and Read, and Video Integration Project) and an expanded care team that includes early childhood community health workers, social workers and psychiatrists. There is strong connection in this model to women’s health and early intervention. The premise of 3-2-1 IMPACT is that together, these interventions can ensure families have access to and are provided preventive, dyadic, and integrated services that address their identified needs.

• PolicyLab/Children’s Hospital of Philadelphia’s Community Clinical Systems Integration Initiative centers public health nurse home visitors as a bridge between preventive care delivery systems in home and clinical settings. Preliminary findings reveal that by creating consistent communication between the nurse home visitor, families, and the child’s pediatric provider, we can reduce burden, enhance coordination of care for patients and elevate health outcomes for families served.

A paradigm shift towards integration

The effectiveness of interventions focused on healthy early childhood development is directly related to not only the trusted relationship of the individuals offering the support, but also coordination among those directly involved, including families. We see great opportunity to improve coordination across systems to reduce fragmentation and improve child health.

PolicyLab has and will continue to engage with and actively learn from colleagues at 3-2-1 IMPACT, Children’s Funding Project, and others to identify which structures are best suited to cultivate collaboration, boost efficiency, and consider sustainability across early childhood systems and programs.

We are excited to be part of a paradigm shift towards improving interconnectedness and efficiency and will look to Prenatal-to-3's study, our own integration model, and other emerging research to gain insight and ensure thoughtful and strategic decisions that elevate the quality of early childhood supports.

The authors thank Shailly Verma, PolicyLab’s former Policy and Communications Intern, as well as PolicyLab colleagues Kali Hackett and Sarah Ingerman for their contributions to this blog post.