# Presentation: 910180

## The Early Childhood System Building Tool

- Marjory Ruderman
- Women’s and Children’s Health Policy Center

***UCLA Center for Healthier Children, Families and Communities***

***Women’s and Children’s Health Policy Center***

## Working Group 

- Kandi Buckland (El Paso County, CO)
- Bill Hollinshead (RI)
- Cathy Kluttz-Hile (NC)
- Rochelle Mayer (NCEMCH)
- Al Romeo (UT)
- Ralph Schubert (IL)
- Meg Booth (AMCHP)
- Tom Rice (UCLA)
- Lorraine Brown and Joe Zogby (MCHB)

## Guiding Principles

- Simple framework with flexible uses
- System-level perspective
- Roles and contributions of MCH viewed from within that perspective
- Value of non-traditional and non-governmental partners
- Importance of state-local linkages and reciprocal roles

## Natural Continuum

**child**

**family**

**community**

**state**

## Early Childhood System Components

**SHARED GOALS**
**for children and families**

**Title V**

**Mental Health**

**Education**

**Medicaid**

**Title V Roles & Activities**

**UNIQUE CONTRIBUTIONS OF SYSTEM PARTNERS**

***others***

**Families**

**SYSTEM PARTNERSHIPS**

**GENERIC STRATEGIES**

**Mental Health Roles & Activities**

**Education ****Roles & Activities**

**Medicaid Roles & Activities**

***others***

***others***

## Shared Goals

| SECCS Focus Area | Child Outcomes | Family Outcomes | Community Outcomes | State Policy/
System Outcomes |
| --- | --- | --- | --- | --- |
| Medical Home  | All children have a source of coordinated, comprehensive and family-centered primary health care.

Examples of outcomes:
—# and %  of children under age 5 with medical homes
—Immunization rates | Services and system meet families’ needs.

Examples of outcomes:
— Rates of consumer satisfaction, including cost and location of services
—# clinics with extended hours
 | Medical homes are linked to other community resources.

Examples of outcomes:
— # and % of children receiving referrals from medical homes 
--- Information is exchanged among service providers (as feasible given privacy constraints)  | Health care financing systems provide incentives to community- or hospital-based pediatric practices to operate as a medical home.

Examples of outcomes:
—State Medicaid, CHIP, and Early Intervention payment rates are adequate to meet needs
—# and % of practices reporting billing codes and reimbursement rates as barriers to providing a medical home |

## System Partnerships

| Child/Family Level | Community Level | State System/
Policy Level |
| --- | --- | --- |
| Mental health care professionals

Center- and home-based child care and preschool providers | Mental health/child guidance and substance abuse agencies 
Child health and child mental health consultants
Developmental disabilities agency

Child Care Resource and Referral programs
Licensing and accreditation agency | Mental health agency 
Mental health associations 
Psychiatry/psychology professional association

Child care agency 

 Healthy Child Care America |

## Programmatic Strategies

- Co-location of services
- Cross-program training
- ECCS focus areas (mental home, mental health, early care/education, family support, parent education)

## System Strategies

- Accountability and measurement
- Quality improvement
- Financing
- Legislative
- Organizational capacity building
- Community capacity building

- Employment related
- Collaboration
- Service systems integration
- Constituency building
- Communications

## Examples of Title V Activities

|  | Family
Level | Community
Level | State System/
Policy Level |
| --- | --- | --- | --- |
| Cross-Cutting | Provide/promote home visiting services for families with young children to facilitate access to all services
Involve parents in planning
Establish and publicize a single referral mechanism for early childhood services (e.g., a hotline)  | Evaluate programs’ effectiveness at meeting organizational goals (e.g., staff development, quality, compensation structure) 
Disseminate best practices for co-located services, inc. school-based health centers  | Convene state-level stakeholders to learn about their roles in early childhood systems development and how each stakeholder gains from others’ contributions
Fund/oversee/support or advocate for cross-service initiatives (e.g., child care health consultants, transportation plans) |

## Potential Uses of Tool

- Articulating goals and work plans
- Identifying measurable outcomes
- Monitoring and quality improvement
- Conveying common concerns and unique contributions of system partners
- Internal education and orientation
- External education and communications

## The Tool is NOT intended to:

- Define a strategic planning process
- Prescribe goals, outcomes, partnerships, strategies or activities

## Helpful Resources on Indicators:

- See handout of selected reference resources
- Also see:
- Webcast of session on measurement for EC services
- Upcoming chartbook of EC indicators (available June 2004 from Child Trends)
- Compendium of indicators from Child Trends* (**www.childtrends.org/PDF/schoolreadiness&progress.pdf**)*
- Advancing State Child Indicators Initiative (*aspe.hhs.gov/hsp/cyp/child-ind98*)

## The Tool IS intended to be:

- A springboard for discussion and ideas

## External Review of Tool

- SECCS grantees and partner agencies
- Local public health representatives via CityMatCH and NACCHO
- Other national organizations
- Zero to Three, including Early Head Start
- Family Support America
- National Governor’s Association

## For more information:

- Marjory Ruderman		Holly Grason
- mruderma@jhsph.edu		hgrason@jhsph.edu
- (301) 891-2215			(410) 502-5443
- www.jhsph.edu/WCHPC/Projects/earlychildhood.html

***Women’s and Children’s Health Policy Center***

## Use of the Early Childhood System Building Tool in Utah

- Alfred Romeo
- Utah Department of Health

## Internal Use

- Share within MCH agency
- Explore list of partners—who’s missing?
- Consider range of goals and outcomes
- Consider range of strategies and activities
- What might have been overlooked in planning session?

## External Use

- Starting point for dialogue about scope of the SECCS grant and early childhood system of services
- Education tool
- To convey range of strategies and activities of MCH program
- To learn about range of strategies and activities of other system partners

## Things to Consider

- Use discussions about tool to bring out partners’ ideas about needs, goals, outcomes, etc.
- Can use selected sections if too lengthy to share with all partners in the process
- Explore and adapt other assessment and planning tools as well

## Small Group Exercise

- Articulate a goal
- Identify the environment for reaching the goal.
- Identify measurable outcomes and data sources.
- Identify generic strategies linked to one or more of the outcomes
- Identify key partners for each strategy and their specific area of accountability.
- Identify specific collaborative or partner-specific activities
- Outline a plan for assessing performance and monitoring progress.