C

Gallery Walk Questions and Input

ACRONYMS AND ABBREVIATIONS IN THE GALLERY WALK COMMENTS

Topic 1: Evidence

1. How can the field better apply what is known at the interface of ECE and health (e.g., screening for developmental milestones)?
   • Monthly happy birthday–type materials sent to families with information on milestones and low- to no-cost ways to help child develop.
   • Better data collection in child care, better use of data to target resources to underserved populations.
   • Business leaders and health administrator awareness and commitment to investments and ROI of ECE.
   • Create community demand.
   • Public awareness for all community sectors is critical.
   • Discharge moms/babies from hospitals with materials that promote talking/singing to infants.
   • Create health teams that include personnel trained in developmental screening and deploy community health workers to do home visits regarding books/songs at home.
   • Define a lean/minimal set of outcome measures at key milestones.
   • Focus on concrete, doable actions at each level and with community, state, and regional leaders to share messages and lessons learned and why it matters—so what? What’s in it for me?
   • Share those effective cross-sector partnerships that are sustainable.
   • Compatible software systems that enable more providers to access records and ability to share information.
   • Consider social genome¹ indicators in longitudinal follow-up.
   • Shift the dialogue to assure promotion of developmental health and healthy relationships (primary prevention).
   • Important to have awareness of predictive risk for developmental delays (e.g., income, adverse childhood experiences) and ensure services (parent support, home visiting, early literacy, implemented at population level).
   • How does ECE fit into the logic model leading to longer, better quality of life and better distribution (more equitable) of those outcomes in the population?

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¹ See http://www.social-genome.org (accessed May 15, 2018).

2. • Bi-directional communication.
   • Not only data, but terminology and goals.
3. What are the gaps and white spaces that need to be prioritized?
   • How to develop an infrastructure of trainers and coaches to deliver evidence-based training to care providers from birth to age 3.
   • Funding.
   • Family-based child care, systemic support, training and learning collaboratives for this group.
   • Raising salaries and ECE training/professional education for providers.
   • How the relationships between parenting and child outcomes vary by culture.
   • Need more evidence on quality-improvement approach in ECE integration work.
   • Impact of the health, safety, and well-being of ECE personal on ECE outcomes.
   • How to reach the informal day care providers, early childhood care given in their homes.
   • How does the Head Start experience fit?
   • Need to consider the social environmental facts that impact the well-being of children.
   • Child poverty is a factor—how is the ECE sector engaging to address the issue for families?
   • Effective communication with families and teachers and health care providers. How is information shared with parents? Are parents able to reinforce learning and advocate for their child’s needs? How do non-regular work schedules for parent’s impact ability to connect with/communicate with providers?
   • What is the relative balance of inputs to child development outcomes: word gap, nutrition, parent education, etc., and the relative investment benchmark of each (i.e., per capita $)?
   • Family violence prevention and healthy relationships.
   • How do you get this type of thinking infusion in higher education for the next generation of professionals?
   • Child outcomes with disparity breakouts.
   • Are optimal ECE programs including trauma-informed care?
   • What efforts are under way to address the “hand-off” process from early childhood to future life-stage work?
   • Who is an ECE provider? Is a home visitor? Is an early intervention provider?

3. • What is preventing school districts from investing in high-quality perks? Funding is an obvious challenge, but there are other known barriers for school districts. And how can these be addressed?
   • Create partnerships with parents instead of a one-way knowledge relationship where trainers know everything and parents don’t.
   • What are the factors that led to scale (25 percent penetration) in “reach out and read,” replication?
   • How do we sustain efforts, beyond funding? Define this better.
   • How do you connect the various health and ECE initiatives in communities? For example, ParentCorps and its three tiers is impressive—what else is going on in NYC and can connect to now?
   • What interventions are successful at closing or minimizing inequities between populations regarding childhood achievement (beyond overall improvements)?
   • Gaps of understanding the language between the various sectors that touch the lives of young children. Alignment so families feel supported in an integrated fashion.
   • Peer-to-peer capacity building with parents and providers/teachers.
   • More understanding about how parents are engaged outside of the provider setting.
   • Role of environmental toxicants (e.g., heavy metals) in successful vocabulary development.
   • Increase the communication between health/education sectors.
   • How to scale when so much engagement of families requires the need to differentiate by method, content, format. Are there identified best practices in the field?
   • Funding—how do we make this a priority for policy makers?
   • On partnerships: what are the critical success factors for creating a multisector partnership?
   • How do we help school systems see ECE and health care services?
   • Support for translational efforts, technical assistance, and cross-sector training.
4. New insights (e.g., what you need to know about parents, teachers, caregivers)
   • What do parents want out of their ECE settings? Where is their voice?
   • As we move toward universal opportunity for pre-K, are the pre-K educators part of the public school system? Same criteria for hiring?
   • How do you define early care and education?

Topic 2: Collaboration

1. How can we accelerate cross-sector collaboration in ECE and health? What do you need to help you and your organization collaborate effectively?
   • Leverage health sector requirements (e.g., CHNA) that can directly spark collaboration with other sectors, particularly as they relate to child health needs.
   • Nonprofit hospital community benefit is a $26 billion federal tax exemption.
   • How far would this go to close ECE equity gaps?
   • Resource redirection.
   • Getting funders to reallocate up front to gain better outcomes.
   • More opportunities for learning between early childhood education teachers and pediatricians.
   • Bridge the knowledge gap in both sectors.
   • Professional development conferences that are cross-sector.
   • Build ECE engagement with pediatric care into ACO quality metrics.
   • Honor the work that has been done over time that leads to where we are now.
   • Bring in as many perspectives as possible—together we are better!
   • Incentives, awareness, common motivation.
   • Regulations that are connected.
   • Incentives.
   • Training—not just usual suspects.
   • Use asset-based approach to leverage what’s working and be willing to work in different ways together.
   • To collaborate with policy professionals and advocates, more attention and strategic thinking/planning needs to happen in regard to financing models.

2. • Funds and incentives work to redirect who is involved.
   • Metrics can drive action and funding drive and link metrics.
   • Streamlining of funding mechanisms.
   • Shared approaches and objectives by main funders.
3. Main barriers to collaboration and the solutions to them?
   • Lack of shared purpose and goals, not enough systems thinking.
   • Competing agendas.
   • There is an art and skill to learn how to do collaboration, especially across sectors.
   • Lack of shared evaluation and mechanisms and data platforms.
   • Upfront commitment to best possible goals and data-gathering processes. This maximizes outcomes and decreases level of needed investment in new data systems.
   • Leadership commitment.
   • Shared information and data.
   • Lack of understanding perspectives, silos.
   • Understanding the benefits and challenges for all partners.
   • Are they effective? How do we measure how collaborations are affecting population-level outcomes?
   • Takes more time that = more money. Few funders really support those costs.
   • Turf.
   • The complexities of the issues surrounding early childhood make it difficult to prioritize where public and private efforts should be focused.
   • Lack of skills on how to build strong partnerships.
   • Common language: agreed upon goals, metrics.
   • Data sharing and alignment.
   • Trust, history of working together.
   • Funding systems tend to be siloed—fund collaborative teams.
   • Core funding for integration functions.
   • Silos, jargon, lack of personal relationships.
   • Lack of funding.
   • Need to have common grounding in theory and best practices in ECE.
   • Independent goals, funders, strategic plans, metrics—must align in a true collaborative.
   • Barriers: disconnected academic communities—solution: opportunities like today.

3. What have we learned from other cross-sector collaborations that could help to inform ECE/health interactions?
   • Intentionality; clear agreement on early outcomes and shared credit; leadership commitment.
   • Review ReThink Health Pathway Model.
   • Be open, understand that formal definitions of quality might not bring all who need to be at the table to the table.
   • Collaboration costs—need “glue” money.
   • Clear rules of engagement: bylaws, expectations, collective impact, buy-in—hard but critical.
   • Center for Work, Health, & Well-Being.
   • Cross-sector collaborations tend to be more effective than larger-scale ways to effect change.
   • Collaborative funding is key.
   • Make case about root cause to push many people together for collaboration.
   • Create small group of passionate leaders to drive and oversee the collaboration; leaders have to bring an equity lens.
   • You need clarity on the results and then identify shared measures and metrics.
   • Personal relationships are key: people make change.
   • The importance of partnering with community members at the program development stage → evolution in authentic, bidirectional way.
   • [Look at] Healthy Monadnock 2020.
   • Be the Change San Diego, ReThink Health Ventures; Atlanta Regional Collaboration for Health Improvement.
   • Relationships are key; start with small goals and wins; it takes time.
   • Partnerships and governance structures are key.
   • Who is at the table, and are they contributing?
   • How are they organized to do work, accountable for impact?
   • How are city, health systems structured and organized to support work, and are they active partners?
   • You need to be intentional, focused, and organized. Effective collaboration does not just happen.
   • Importance of anchor institutions.
4. New insights?
   • Let health sector take more of a leadership role in early childhood development system building 0–3.
   • There is more to sustainability than funding.
   • Rethink what is already in place, asset-based approach.

Topic 3: Policy

1. What are the main policy levers that could support the spread/scale of health/ECE coordination?
   • Require hospital to use a percent of community benefit dollars to invest in ECE.
   • Developmental screening for all.
   • Strengthen focus on well-being and social emotional learning for workforce.
   • Specific for Paula—require 25 percent of nonprofit hospital tax advantage provided in each local area (but what about for profits?).
   • Developing competencies that elevate all without making care-taking inaccessible to those in our immigrant or low-income communities. Think access to providers that look/sound like me.
   • Cohort training models, cultural brokers, developed with the communities.
   • Universal pre-K.
   • Quality standards for providers.
   • Training for parents.
   • Nurse–family partnership and/or similar home visiting programs.
   • Need greater alignment of MCH and ECE.
   • Broaden advocacy base to unsuspecting partners, such as Fight Crime, Invest in Kids.
2. What policy actions can be taken to address some of the challenges in spreading and scaling effective early childhood care and education interventions and programs?
   • No more investments in new models; focus on scaling those we know work.
   • Health plans provide enhanced rates for implementation.
   • Centralized repository of evidence-based practices tied to health and education guidelines.

3. • Give funding for careful implementation and innovation not just evidence-based programs.
   • Federal tax incentives.
   • Engage national employers.
   • Pay for value-based health care to drive ECE outcomes since all of the dollars are in health care—use these dollars to pay for what works in ECE.
   • Requiring definitions of quality to be rooted in community values in addition to evidence-based practice so all will want to access high-quality care.
   • Focus more on building capacity to teach practice in adults in settings other than evidence-based programs.
   • Braided funding to support effective inclusion practices.
   • Federal government provides technical assistance and support focused on prevention.
   • Advocacy rooted in communities that builds demand for quality.
4. What needs to be done to support and increase investments for new ideas and innovation in early childhood care and education?
   • Focus on workforce and packaging what they need in evidence-based supports, including compensation.
   • Elevate best practices with public–private partnerships—look at tobacco or sugar-sweetened beverage taxes, tax credits, business champions for fundraising.
   • Create scorecards for each elected official’s district/jurisdiction that includes reading by grade 3 by district/race/ethnicity/income; also graduation rates and link to early childhood education rates.
   • Training and education of health care providers at every level—undergrad, medical school, residency, and continuing education—should include exposure to role of early childhood care and education.
   • Get early childhood interventions (high-quality, accessible early care and learning) on radar of ACOs and hospitals and health systems before they move to value-based payment system.
   • Make the case; find start-up prevention dollars, show how money is saved, costs avoided through prevention to sustain and increase investments.
   • Health care and education—where money is in the system and sector that save when early childhood prevention is done well.
   • Need to explore how existing funds are being used to support ECE and health—look for duplication of effort.

4. • Ensure that business leaders and politicians understand the ROI in multiple budgets from ECE money.
   • Don’t assume that a rationale of benefit to children is sufficient.
   • Use implementation science—performance evaluations more for learning, not just focus on outcomes.
   • CMMI needs to release FOA on children.
   • Establish economic developmental sequelae—cost to society.
   • Frame the message and ask to speak to language/interest of different sectors.
   • Think outside the “children’s advocacy” silo.
   • →research→advocacy→messaging→research, etc.
   • Local community organizing.
   • Understand how tax policy can be part of the answer.
   • Include ECE in student funding formula for school.
   • ECE and K–12 health systems—[public] health, pediatricians, and business all work together.
5. What policy actions can be taken to increase collaboration and synergies between those working in the health sector and the early childhood care and education sector?
   • Align, harmonize, or collaborate on community needs assessments both sectors do (see National Academies report Communities in Action).
   • Mandate screening in pediatrics for social determinants of health.
   • Have IRS-required attention to ECE as a part of every CHNA.
   • Absenteeism as common outcome.
   • Need the forums for conversation, engagement, and problem solving between and across sectors.
   • Link ACO and MIPS/MACRA quality metrics with early childhood care and education for pediatric visits.
   • Required ECE landscape assessment as part of CHNA.

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