The extraordinary influence of the early years has profound implications for promoting vulnerable children’s healthy development and learning. Recent advances point to the link between early childhood exposure to toxic stress and negative downstream outcomes. While awareness of the need to address toxic stress has increased, effective evidence-informed interventions that either mitigate or reduce the impact of toxic stress are not similarly widespread.

Recognizing that young children experience near universal access to the primary care provider in the early years of life, pediatric primary care thus represents a critical setting in which to develop, test, and scale innovations focused on toxic stress. Primary care providers have long been recognized as playing a central role in promoting development, detecting developmental and behavioral concerns, and ensuring linkage to services. Help Me Grow (HMG) is an efficient and effective system that assists states in achieving cross-sector collaboration to identify at-risk children and ensure connection to community-based programs and services. By supporting vulnerable children and families, HMG serves as a critical resource for primary care providers to mitigate the impact of toxic stress. More recent innovations that similarly enhance pediatric provider capacity to mitigate toxic stress include Educating Practices in the Community (EPIC) and Practice Quality Improvement (PQI). EPIC and PQI combine academic detailing, continuing education, and practice quality improvement, which together are effective in introducing and sustaining practice change. A framework for continuous quality improvement (CQI) ensures that evidence-informed innovations are successfully implemented within the practice setting by requiring that providers identify quality improvement aims, assess performance in meeting specific targets, and implement small tests of change to drive optimal outcomes. Together, these interventions and an overarching framework for CQI enhance the ability of pediatric primary care providers to engage parents through developmental surveillance, screening, and linkage to services and by seeking to identify and support the development of specific protective factors.

The HMG National Center is working with a select cohort of HMG affiliate sites to embed this comprehensive intervention in local pediatric practices. Ultimately, the lessons learned through this intervention can be disseminated throughout the National Network to strengthen the child health provider outreach efforts of HMG affiliates.

This work is generously supported by The JPB Foundation.

As exemplified by HMG dissemination, the success of comprehensive system building to promote children’s optimal healthy development is predicated on the effective engagement of families and their communities. Strategies to strengthen family resilience and capacity, essential to promoting children’s optimal healthy development, must secure family collaboration in an acceptable, feasible, and culturally-appropriate manner. The Well Visit Planner (WVP), developed by the Child & Adolescent Health Measurement Initiative (CAHMI), is a proven web-based technological innovation which offers the potential to strengthen parent capacity to promote children’s healthy development.

In partnership with CAHMI, the HMG National Center will diffuse the WVP to a subset of HMG affiliates with demonstrated capacity to leverage this innovation to further their ability to engage parents in identifying and prioritizing concerns and empower them to improve the quality of their well-child visits. HMG affiliates participating in a Community of Practice (COP) will receive targeted technical assistance and opportunities for focused and ongoing learning with the goal of identifying best practices for integrating the WVP within their centralized access point and child health provider outreach activities. Evaluation of a set of core metrics and the overall success of implementation will inform subsequent dissemination among affiliates across the nation.

Diffusion of the WVP has the potential to a) promote the healthy development of all children, by supporting a comprehensive effort to identify and address needs as early as possible; b) create integrated systems of care, by linking child health services to community-based resources; and c) make better use of existing resources, by strengthening the effectiveness of primary child health services. More specifically, bringing the WVP to scale will support the national network of HMG affiliates in implementing a novel, technological approach to parent engagement, will identify successful strategies to enable widespread use of the WVP, and will inform policy and system development.

This work is generously supported by The Aetna Foundation.

The critical role of early childhood professionals in mitigating the impacts of toxic stress is increasingly recognized in the field. Recently, many have adopted a strengths-based approach to working with young children and their families that reflects the Strengthening Families Protective Factors Framework developed by the Center for the Study of Social Policy. The framework guides professionals to support families by promoting social connections, knowledge of parenting and child development, social and emotional competence of children, parental resilience, and concrete support in times of need.

Given the complexity of measuring the impact of early childhood interventions and the merits of adopting a strength-based approach, this project seeks to expand the use of the Protective Factors Framework in program design, implementation, and evaluation through the HMG National Network. In partnership with CSSP and the Office for Community Child Health, the HMG National Center will operationalize the Protective Factors Framework by supporting the integration of protective factors as a tool to reflect on HMG workflow and process improvement. This project consists of a structured learning collaborative focused on strengthening the protective factors; participants in the collaborative leverage a Program Self-Assessment Tool to reflect on their existing processes and procedures and whether and how certain workflow improvements could increase their capacity to strengthen families.

Throughout the learning collaborative, participating sites will use Quality Improvement methodology and ongoing Plan-Do-Study-Act (PDSA) cycles to introduce small tests of change and identify and share best practices to strengthen the protective factors through their internal program structure and protocols. We anticipate that demonstrating successful utilization of the Protective Factors Framework during the one year of this project will yield the tools and experience to enable the HMG National Center to support the National Network in adopting the Protective Factors framework in their early childhood system building efforts.

This work is generously supported by The Aetna Foundation.

Family and community engagement is a core component of the HMG model, and serves as one evidence-informed strategy to engage families as key partners in developmental promotion, early detection, and linkage to services. The proposed project seeks to leverage an existing innovation in family and community engagement that builds on the benefits of creative play as a foundation for learning and development. Books, Balls, and Blocks (BBB) events are structured events held in the community, and consist of the following core components: 1) activity stations for children and families, 2) access to developmental screening and sharing of results, 3) trained staff and volunteers to support activities and screening, and 4) through access to HMG, referral and linkage to appropriate programs and services. These events provide a structured venue in which to provide developmental assessment, parent and child education, and community resource education, and effectively brings HMG to the family. In fostering parent engagement around a series of fun and community-based activities, BBB events operationalize the protective factors known to support optimal child health and development including parental resilience, knowledge of parenting and child development, and social connections.

Within this project, the HMG innovators that developed the BBB model will work in conjunction with local and state early childhood leaders to develop and implement a structured BBB program that reaches communities across the state of Connecticut. Targeted campaigns will ensure that children and families are aware of and can access events planned and delivered in order to reach a large and diverse population of families. Ongoing feedback from state leaders, staff, and parents and caregivers will provide evidence of the feasibility and efficacy of this family and community engagement strategy. Ultimately, lessons learned from the statewide dissemination of BBB events will serve to identify strategies that can support subsequent diffusion across the broader HMG affiliate network.

This work is generously supported by The LEGO Community Fund U.S.

Mid-Level Developmental Assessment (MLDA) provides brief, expedient assessment of children with behavioral or developmental concerns identified through surveillance and screening and triages these children into community-based intervention services or higher-level evaluation. Traditionally, children identified as at-risk through surveillance and screening are referred for costly, full evaluations to assess eligibility for categorical services. This two-tiered system leaves no “middle ground” to address the needs of children with mild to moderate concerns who are unlikely to qualify for categorical services and could, instead, be connected to helpful, community-based services. MLDA ensures that children with mild to moderate concerns receive timely evaluations and linkage to services, while preserving tertiary level services for children with greater need.

The MLDA model was originally piloted with support from the Child Health and Development Institute of Connecticut. In Connecticut, The Village for Families & Children developed an approach to MLDA that includes: collateral information review, parent interview, developmental assessment, and a family feedback session in which families are provided with a Family Service and Recommendation Plan outlining those services and supports that would be most helpful for the child. Agencies providing MLDA seek to ‘close the loop’ by directing MLDA cases to HMG for care coordination and linkage to recommended services.

In an effort to close a key system gap in assessment options for children with mild or moderate concerns, the HMG National Center will diffuse the MLDA model to HMG affiliates in an effort to increase system-level efficiencies, maximize access to community-based services, and minimize service redundancies. This diffusion effort is supported by a number of strategies, including peer-to-peer learning and technical assistance, to engage HMG affiliates in the adoption of the MLDA model.

This work is generously supported by the W.K. Kellogg Foundation.

The Care Coordination Collaborative (CCC) began in Hartford, Connecticut in 2010 as a strategy to improve communication among the many different sectors and programs providing care coordination services to children and families. The goal of the CCC approach is to “coordinate the care coordinators” in an effort to ensure efficiency and effectiveness across the child health system and support children and families in navigating and connecting to community-based services. The CCC model consists of ongoing meetings with a variety of child-serving programs; meetings focus on learning about new and existing local and state resource providers, reviewing challenging cases to discuss possible approaches, identifying and developing solutions to common barriers within the system, and supporting the pediatric medical home in providing effective care coordination to families.

Care Coordination Collaboratives will function optimally as part of a HMG system, given the alignment between the Care Coordination Collaborative and HMG. A core component of HMG is to promote cross-sector collaboration in order to build efficient and effective systems that mitigate the impact of adversity and support protective factors among families. Many HMG affiliates include this as a goal of their community outreach efforts; yet, there is also opportunity for HMG affiliates to adopt the CCC approach as a mechanism to strengthen their capacity to bring greater efficiencies to the system.

The HMG National Center will diffuse the CCC model to HMG affiliates as a strategy to enhance community outreach efforts, orient care coordination partners around a shared goal, and bring greater efficiencies to the system. This diffusion effort is supported by a number of strategies, including peer-to-peer learning and technical assistance, to engage HMG affiliates in the adopt of the CCC model.

This work is generously supported by the W.K. Kellogg Foundation.