Erin Cornell, MPH, Von Jessee, MA, and Paul Dworkin, MD
Very often we are asked the question “what is the evidence base for Help Me Grow?”
When Help Me Grow (HMG) was first introduced as ChildServ in 1997, a number of early studies described the HMG model and also presented early evidence of the feasibility and impact of HMG.1,2 This initial evaluation of the model generated the evidence needed to think about further spread and scale of the HMG concept: fast forward to 2017, and over 25 states representing more than 90 HMG systems have implemented the model.
The adoption of HMG by so many communities has further confirmed the feasibility and efficacy of the model. The assumptions that initially prompted the development of HMG still ring true in many communities: young children are eluding early detection and, even once identified, face difficulties in navigating the complex landscape of programs and services. HMG serves as a critical, contemporary solution to ensuring the continued advancement of developmental promotion, early detection, referral and linkage.
Yet unlike many programs based in early childhood, HMG instead functions as a system, bridging together those key core components that support early detection, referral and linkage: a centralized access point, family and community outreach, child health provider outreach, and ongoing data collection and analysis to inform system improvements. HMG affiliates that have gone on to implement the model seek to align with those core components, and our annual Fidelity Assessment allows us to measure and track affiliate progress in scaling the model by categorizing their efforts as exploration, installation, or full implementation.
Yet even with a rigorous approach to fidelity, one of the critical factors supporting the long-term success of HMG is allowing for local adaptations during implementation. For example, communities often pursue a variety of agencies to serve as a centralized access point, weighing relevant considerations such as existing resources, partnerships, and infrastructure. Two HMG affiliates might serve two distinct target populations, adopt unique approaches to researching resources and connecting families to programs, and leverage different methods to engage providers with HMG.
This variation allows a HMG affiliate to tailor the model to fit local needs and context and, in doing so, ensures that HMG will serve as a robust, sustainable approach to supporting young children and families. Yet the broad nature of the HMG system model and local variations in implementation shift us further away on the traditional program spectrum. And that, in turn, shifts us further away from traditional evaluation paradigms that seek to quantify and then replicate specific programmatic outcomes.
We see this is a strength, rather than a limitation, of our work. Each new HMG implementation is another opportunity to learn critical and unique lessons about how to best implement a comprehensive system with the capacity to meet the needs of young children and families. Given that all HMG systems adopt the same model (as defined by HMG core components), successful outcomes in one HMG system can inform implementation of other systems. Such findings may not be “generalizable” in the traditional sense but, by having local context, we can work to identify factors shown to be repeatedly critical to HMG success and seek to replicate those across the network. The HMG network offers the capacity to ask and answer different questions about the design of systems to advance developmental promotion, early detection, and referral and linkage.
So what does this mean for our work? Here, at the National Center, we invest in two core evaluation strategies:
First, we continue to encourage and promote local evaluations of the impact of HMG; this includes the development of a shared approach to measurement. All HMG affiliates are encouraged to track identical local indicators across the core components of the HMG model in an effort to support a single language around relevant measures and the strategies that can be used to evaluate those measures at the local level.
Second, we are intentional in seeking opportunities to fill critical gaps in our evidence base. Of course, it is commonly acknowledged that HMG, given its central position in an early childhood system, has the potential to impact child- and family-level outcomes. Linking children and families to needed services can be expected to drive positive outcomes in both the short- and long-term. Children receive the help they need and, over time, likely experience developmental gains that promote school readiness and improved academic outcomes. However, many variables contribute to these downstream outcomes beyond HMG in isolation, in particular the experience of children and families at those programs and services to which HMG refers. Yet we recognize that HMG, as a system model, likely achieves gains in other sectors to which we have paid significantly less attention from a measurement standpoint. For example, HMG, in creating and sustaining key relationships with partners, has the capacity to improve overall system efficiency, as well as the degree of integration among agencies serving children and families. This strengthens the system, as opposed to strengthening families, but is an equally impactful measure. In the future, in partnership with HMG affiliates, we will identify opportunities to broaden our measurement focus across these other areas of the system.
The “evidence base” for HMG is thus unique to each affiliate, informed by lessons learned from evaluations led at the local level. As our comprehensive knowledge of affiliate implementations grows, and as we capture a greater number of metrics across HMG systems, we are well positioned to enhance our knowledge of strategies that support successful system building. At the national level, we continue to seek opportunities to broaden what we know about strengthening both families and early childhood systems to enhance our capacity to advance developmental promotion, early detection, referral and linkage.
- Dworkin PH. Historical overview: From ChildServ to Help Me Grow. Journal of Developmental and Behavioral Pediatrics. 2006;27(1): S5-S7.
- McKay K, Shannon A, Vater S, Dworkin PH. ChildServ: Lessons learned from the design and implementation of a community-based developmental surveillance program. Infants & Young Children. 2006;19(4):371-377.