Meeting Families Where They Are: Child Care Navigation Supports Through Primary Care

There is an enormous amount of evidence demonstrating how quality child care environments can have long-term benefits for children, including increased cognitive abilities, improved language development, better peer relationships and less conflict with caregivers. However, many families still struggle with independently vetting the best caregiving arrangements for their children. With pediatric primary care serving as a regular, trusted touchpoint for families regarding information about their children, our team at PolicyLab is working to build capacity within this part of the health care system to help families navigate child care decisions. 

Below I share not only what we have learned thus far from engaging with the child care and health care systems, but also the approaches we are taking to build this effort.  

Partnering With Primary Care to Enhance Families’ Knowledge of Quality Child Care

In the absence of quality child care, families not only lose access to positive socioemotional and behavioral supports for children—which are critical to their success in early education—but are also more regularly exposed to safety hazards introduced by unregulated child supervision options that may place children with unsuitable or unprepared and inadequately trained caregivers, such as elderly kin, neighbors or non-biological maternal romantic partners.  

Evidence from PolicyLab’s evaluations of Pennsylvania’s evidence-based home visiting programs identified the lack of accessible quality child care as a foundational barrier to outcomes for child safety. PolicyLab investigated ways for the health system to address this barrier and, with the support of the Vanguard Strong Start for Kids program, launched the Community Clinical Systems Integration (CCSI) pilot initiative in 2019. CCSI aims to build the capacity for and support to home visiting and pediatric primary care to improve families’ understanding of and decision-making towards quality child care settings.  

Specifically, our initiative created a Childcare Navigator role (CCN), which I took on in the fall of 2019. Both my personal and professional experiences with early care and education (ECE) navigation have led me to a professional commitment to use my voice to impact the expansion of knowledge and access that families and their children have to high-quality early learning experiences. 

Alongside the rest of the CCSI team, I am working to develop enhanced, direct support to home visitors, pediatric primary care, and families, as well as to identify opportunities and barriers to building systems-level coordination between home visiting, pediatric primary care and the child care sector. Leaning into the research component of our work, we interviewed many people involved to ensure that we properly understood the scope of need for child care navigation and support. 

Lessons Learned: The Family Perspective 

Together with other colleagues who work in the child care space, I have conducted enlightening interviews with families, nurse home visitors, pediatric primary care providers and, most recently, child care owners and operators. 

Our interviews with families revealed that there is a wide variety of considerations that affect decision-making around quality child care, including timing/desire for the need of care, difficulties surrounding eligibility and navigation of child care subsidies, and child care locations and hours that meet families’ current needs. We also learned of barriers to seeking quality care, such as the use of child care and its relationship to intimate partner violence; varying opinions on what constitutes quality care, including personal beliefs, culture/religion, and priority factors; and the role that the mass media plays in heightening families’ fears of child maltreatment within child care. 

These lessons affirmed that both the existing child care infrastructure and the process for deciding where to send children for care is complex, and families need navigation and educational support to find safe, adequate caregiving environments that fit their needs. 

Barriers to System-Level Coordination 

Throughout this work, we have also learned that both pediatricians and home visitors in health care see a role for themselves in supporting family decision-making and understanding of quality child care. Our interviews and focus groups with these professionals revealed, however, that time constraints and knowledge gaps about the child care system create barriers for them in adequately addressing families’ questions and concerns. 

Pediatricians overwhelmingly stated that additional clarity around families’ eligibility and access to child care subsidies for quality options were of greatest need. While health care professionals were most familiar with connecting patients to early intervention and medical child care options, navigation for safe, quality caregiving arrangements for other specialty populations—such as those who experience homelessness, foster and immigrant families and children with behavior challenges—proved to be difficult. 

Early childhood education professionals agreed that they are challenged by poor communication and difficulty in the exchange of information between themselves, the health system and families. Families often serve as intermediaries between the health and child care systems, which not only creates undue burden, but jeopardizes effective communication workflows that could best support children’s health needs. 

Jointly, families and family-serving systems felt that increased education of and support in the navigation of these complex systems could be a valuable resource.

Supporting ECE Throughout the Pandemic and Beyond

I would be remiss if I did not acknowledge that the COVID-19 pandemic completely altered the way families make decisions about when and where they want to place their children in child care. Throughout the pandemic, our team at PolicyLab has been working to help the child care sector interpret COVID-19 guidance and develop complimentary resources to support staff's ongoing professional development. While the long-term consequences of the pandemic remain unknown, the crisis has clearly demonstrated how the fragility of the child care system can adversely impact the greater workforce and, consequently, the families we serve through CCSI. 

Our work to support child care centers during the pandemic has only cemented what we know is the importance of a strong child care system to support children, families and community health. 

Informed by these lessons learned, CCSI will continue to thoughtfully build a financially sustainable infrastructure that supports burdened health care personnel and the child care system. Through the development of a multi-layered approach and continued engagement with collaborators and families, we plan to address identified and emerging needs by focusing on improving the knowledge of our health system’s personnel when it comes to quality, safe child care; providing direct support to families with enrolling in quality care; and bettering communication between the health care and child care systems. 

Our pilot provides a strong foundation and team of experts who innovatively and intentionally respond to the reality that health care providers, families and the child care system are navigating. While there is still much work to be done, we are excited about how this type of work could support families and expand health personnel’s resource capacity moving forward. We challenge new and experienced health staff to consider other sustainable approaches to strengthen the attitudes, knowledge and skills of those working to support the overall well-being of children in early childhood education.

To follow the progress of our work in addressing system-level barriers to family's access and understanding of quality child care, visit our project page “Community Clinical Systems Integration – Early Childhood Education Supports,” to share in the continued success of our work and to receive updates regarding the progress towards our project’s aims.