By: Paul H. Dworkin, MD

I am privileged to have the opportunity to speak with audiences around the country about the dissemination of the Help Me Grow model and its role in early childhood comprehensive system building. Each speaking engagement presents a unique opportunity to engage with diverse audiences, validate or challenge our key concepts, and expand our knowledge. Indeed, a key role of our Help Me Grow National Center is to facilitate the sharing of best practices and lessons learned among our affiliates. Most recently, I had the honor of delivering the keynote address at the First 5 Association Help Me Grow Statewide Convening in Fresno, California.

I am grateful that the First 5 Association extended the invitation, as we are indebted to California and First 5 for the current status of Help Me Grow. I am always mindful that the expansion of Help Me Grow beyond Connecticut started in California with Help Me Grow Orange County. The success there encouraged us to pursue support to other states similarly interested in implementing the model. Today, I am humbled by the extent to which the model itself has grown to be a major part of early childhood system building efforts in more than 30 states.

California has realized much success with its Help Me Grow framework, which includes multiple Help Me Grow systems operating with county-level backbone organizations that align under a single statewide association, First 5. The evolution of Help Me Grow in California taught us the merits of utilizing a multiple system affiliate model with a statewide backbone organization as an alternative to a single statewide system, as originally designed in Connecticut. Other distinct and important contributions from the California experience include the use of unique funding streams to sustain Help Me Grow efforts (e.g., California tobacco tax dollars), the use of developmental screening as lever to advance an integrated approach to early detection, referral and linkage, and the importance of embedding Help Me Grow within a master plan for early childhood system building.

In preparation for my talk, Heather Little, Systems Director for the First 5 Association of California, shared the suggestion of Karen Pautz, First 5 Siskiyou County Executive Director that I revisit my talking points from the 10^th Annual Help Me Grow Forum held last spring in Buffalo. I enthusiastically embraced this request.

In Fresno, as previously in Buffalo, I presented what I feel are the top 10 attributes of a highly functioning, comprehensive early childhood system. I suggested that such a system:

• Ensures that providers consistently elicit parents’ priorities, opinions, and concerns through open-ended, parent-led discussions as part of effective developmental surveillance and screening;
• Enables providers to effectively and confidently engage in developmental promotion, early detection, and, when indicated, referral and linkage to community-based programs and services;
• Strengthens developmental promotion through embedding in child health and other child service sectors such efficacious models as Healthy Steps, Medical-Legal Partnership Program, Project DULCE, Reach Out and Read, Video Interaction Project, group well-child care (e.g., Centering Parenting), and apps and other digital tools (e.g., Sparkler and Vroom);
• Strengthens care coordination capacity within the child health services sector, and across sectors, by increasing access to Help Me Grow systems to ensure families are easily able to access the services and supports they need to thrive;
• Expands traditional performance metrics to include school readiness, third grade reading levels, high school graduation rates, physical health (e.g., healthy body mass index), as well as measures of hope and happiness;
• Encourages insurance companies to reimburse providers for using evidence-based strategies to enhance protective factors, such as families’ resiliency, social connections, access to concrete support in times of need, and capacity to promote their children’s social-emotional development;
• Advances payment models, as well as the blending of administrative and financial resources across sectors, that support childhood programs and services with confidence that future savings in behavioral health, special education, and the juvenile justice system more than justify investments in child health services;
• Encourages a strong interface between child health services and all other crucial, family-supporting sectors to facilitate family connections and access. Such sectors include early care & education, family support, transportation, neighborhood health & safety, housing, workforce development, and food & nutrition;
• Increases understanding that child and family services are critical elements in a comprehensive, coordinated, community-wide approach focused on preventing low- and medium-risk children and families from becoming high risk, as well as providing intensive services to those who already have reached high-risk status; and
• Expands the target population for programs and services from children with delays, diagnoses and disorders to all children, especially those who are at increased risk for poor developmental and behavioral outcomes due to adverse social and environmental factors.

I acknowledged that achieving all of these attributes may seem impractical and overwhelming; however, each element is part of Help Me Grow’s experience and capacity. Furthermore, comprehensive system building is within the reach of every Help Me Grow jurisdiction.

As at the Annual Forum, I noted that we have already accomplished far more than I ever envisioned possible during Help Me Grow’s early years.  Indeed, our current status of 99 Help Me Grow systems and 31 state affiliates across the nation, with 23 California county systems, is worthy of reflection and celebration. However, we now must set our sights even higher and envision far more as we share our common vision for 2020 and beyond and strive to learn from best practices in early childhood system building.

I used the Fresno convening to reiterate my five key “take away” priorities from the 10^th Annual Forum.  Given the Annual Forum’s ambitious and hectic “three-ring circus” atmosphere, I admit that my reflections are somewhat biased and dependent on those sessions which I attended.  Nonetheless, I believe they are worthy of our collective consideration. I suggested that going forward:

1. We must focus on the root causes of disparities and inequities. The injustices of poverty, immigration policy, and systemic racism demand that we be more explicit in addressing social, environmental, behavioral, and environmental factors as we advance universal approaches that target those most vulnerable (i.e., “targeted universalism”).
2. We must prioritize and advance sustainability beyond 1-2-year grant/budget cycles through such strategies as capturing the return on investment/cost savings/cost benefit of the Help Me Grow model, embracing key drivers of importance to jurisdictions such as workforce development, and creating integrated data platforms for all sectors and all providers, such as Orange County’s Screening Registry.
3. We must embrace strength-based outcomes as metrics to measure our success. We have validated the “goodness of fit” between Help Me Grow and the Protective Factors Framework from the Center for the Study of Social Policy’s Strengthening Families initiative. We must advance such key outcome measures as parental resilience and family coping, including the use of strength-based measures within value-based payment models, such as measures of children’s hope, happiness, and well-being.
4. We must engage a larger cadre of parents as full partners in our work and our products. In particular, we must engage more fathers in our work.
5. As emphasized in a call-to-action at the Annual Forum by Help Me Grow National Center Executive Director Kimberly Martini-Carvell, we should feel emboldened to view our work in advancing Help Me Grow as a nationwide movement, evolving from incremental to transformational change and from integration to a model of inclusion.

In concluding my keynote, I lamented that many of our professional organizations, public agencies, and even many funders continue to think too incrementally about individual interventions operating in siloed sectors and that the true notion of system building is elusive for many. In contrast, California is an inspiring example. I cited Governor Gavin Newsom’s historic investment in early childhood education of over $2 billion as evidence of a strong parent and family agenda, as well as the creation and implementation of the state’s master plan for early education to ensure that all children in California have the critical foundation they need for healthy development and learning in the earliest years. In addition, I cited the Governor’s call for “CA for all” as validating the importance of “targeted universalism,” and key appointments, including First 5 Executive Committee member (and fellow panelist) Kris Perry as Deputy Secretary of the California Health and Human Services Agency for Early Childhood Development and Senior Advisor to the Governor on Implementation of Early Childhood Development Initiatives, as well as our pediatric colleague Dr. Nadine Burke Harris as California’s first-ever Surgeon General.

Finally, I paid tribute to California’s acknowledged status as a national leader. In support of this treatise, I shared a quote from a recent article in the Atlantic Monthly, which stated, “The truth is that much of the rest of the country is becoming more and more ‘California-ized’ with each passing year…” The article quoted book author, Gladwin Hill, who 50 years ago noted that innovations born in California and once mocked were soon imitated everywhere else: “swimming pools, drive-in banks, backyard barbecues, hot-rods, Capri pants, ‘ranch-style’ homes, Mexican food, the surfing craze …” The article concluded that “today, one could easily add environmental regulation, robust state-university and community-college systems, alternative-energy production, consumer protection, and sweeping changes in social policy and public mores, including gay marriage.” I propose that the remarkable success in California suggests that Help Me Grow be added to this impressive list.