With key partners, Natural Wonders Partnership Council of the Arkansas Children’s Hospital, and Arkansas Advocates for Children and Families, Arkansas’ Campaign for Grade-Level Reading organized a day-long meeting, “Early Investment Strategies to Promote Healthy Growth and Development.” We used this strategy to learn about the status of screening, referral and intervention, and to inspire collaboration to kick start a more robust, effective and comprehensive system that will result in a very substantial increase in low-income children who are healthy, on track and ready for school.
A wide spectrum of stakeholders engaged in supporting Arkansas’ young children and families gathered to discuss this approach to strengthening children’s early success. Stakeholders represented primary care, pediatrics and public health, early childhood education, early intervention, home visiting, mentalhealth and a range of other professions and organizations that serve the state’s children and families.
The group heard important messages from a federal leader, Dr. David Willis, a nearby state leader, Dr.Marian Earls, and several Arkansas experts representing different sectors that are and need to align their roles in developing the system.
Dr. David Willis, Director of the Division of Home Visiting and Early Childhood Systems at the U.S. Department of Health and Human Services, presented a vision of a comprehensive system of developmental promotion and steps to ensure that children are on track and ready for school, lifting up the following key points:
1. There is one science of early brain and child development: The relational experiences between parents/caregivers and children in the first 1000 days build the health foundations for children’s physiological, behavioral and early language and learning capacities. It is essential to break the paradigm that children develop on their own.
2. The screening, referral, and follow-up needed requires a fully integrated and comprehensive system at the local, regional, state, and one-to-one levels. The health system provides the first platform for developmental promotion since 95 percent of children from birth to age 1 are seen in this space and it provides the chance to find out about both family strengths and adversities or risks. Health providers need to know what community resources are available before they are likely to ask about family challenges that will elicit need for supports or services.
3. Developing these comprehensive integrated systems requires time and calls for the “energy of leadership.” Start with place-based initiatives, involving many systems (i.e., not single sector); then roll up to the state level, use “practice redesign,” such as Help Me Grow, to help organize the system. Consensus indicators offer a way to talk across sectors, develop a baseline and keep everyone at the table; use data also for geo-mapping and align data systems. And promote messages to parents about engagement, hope and possibility.
Dr. Marian Earls, Director of Pediatrics for Community Care of North Carolina, helped initiate and continues to lead one of the most successful ABCD (Assuring Better Child Health and Development) projects in the country. In reviewing the history and current status of this comprehensive screening that is now statewide and has the highest rate in the country (92%), she identified several critical components:
1. Developmental and behavioral surveillance and screening have several purposes: early identification of children’s delays and promote healthy development, parental promotion and support, engage parents as experts on their children, identify parental strengths and provide anticipatory guidance.
2. ABCD is a Quality Improvement approach in primary care, using agreed on standardized screening tools (developmental, then added social-emotional/behavioral, autism, and most recently maternal depression) in well-child visits and sharing data on a quarterly basis (for the past 10 years).
3. A State Advisory Council comprised of stakeholders from multiple sectors, including leadership of the state’s chapters of the American Academy of Pediatrics and the Academy of Family Medicine meets quarterly (and has for 16 years) to build consensus and address administrative and policy barriers.
4. Achieving significant policy change, including successively expanding Medicaid reimbursement for recommended screenings.
5. Aligning goals with state partners, including departments/state organizations responsible for education (including Part C/Early Intervention; preschool), early childhood care and education, and public health/Medicaid
6. Bringing together local primary care providers and community child/family-serving agencies, to foster mutual understanding, build relationships and ensure follow-up from screenings and feedback to medical homes
7. Embedding implementation within Community Care of North Carolina, the state’s Medicaid Managed Care infrastructure.
Arkansas experts included:
- Dr. Chad Rogers, pediatrician and incoming President of the AAP Arkansas Chapter who focused on primary care providers
- Nikki Edge, Associate Professor, UAMS, Dept. of Family and Preventive Medicine, who focused on social-emotional development and screening
- Ravyn Hawkins, Staff Development and Policy Coordinator, First Connection (Part C, IDEA) and Dr. Eldon Schulz, Rockefeller Professor, UAMS, Departments of Pediatrics and Physical Medicine and Rehabilitation who together laid out the Early Intervention system and its gaps
- Tonya Williams, Director, Division of Child Care and Early Childhood Education, Arkansas DHS, who identified benefits and challenges of screening and follow-up in early childhood settings.
Galvanized by inspiring and informative presentations and brainstorming sessions designed to stimulate ways to “turn the curve,” participants committed to a continuing collaboration to develop and sustain an effective system for Arkansas’ young children and the following next steps:
- Recognize the urgency of moving ahead, drive toward specific goals, and use metrics to measure progress
- Use a Continuous Quality Improvement approach
- Ensure an even wider group of stakeholders participate in the collaboration
The Host Partners agreed to take responsibility for initiating next steps, including the next opportunity to bring stakeholders together.
Blog post drafted by Ann Rosewater.