In the final session of the workshop, George Isham, a roundtable co-chair, and Phyllis Meadows, a senior fellow in the health program at the Kresge Foundation, reflected on the workshop presentations and discussions and called upon roundtable members and participants to share their final observations.
Reflecting on Lantz’s point about the perils of an altered dependency ratio (see Chapter 4), Isham observed that the older generation might not necessarily see the benefit of some of the policy changes concerning early care and education. At the other end of the spectrum, children’s advocates often assume that children’s welfare itself is sufficient justification for investments in early care and education. There is a need to look beyond the short-term outcomes and develop a rationale that is persuasive to other segments in society. There is a two-way learning curve involved in making an effective case for broader investment in early care and education in order to win supporting votes from across a wide spectrum of the country.
Isham also suggested that the tax incentives discussed by Higgins (see Chapter 4) have much broader applications for funding population health improvement policies and initiatives beyond early childhood. He suggested that the roundtable continue to pursue those avenues.
A one-size policy package does not fit all, Isham said, and it will be important to more fully understand the individual needs of states and regions across the country and also their policy environments (e.g., what works best for motivating local decision makers to support the type of
early childhood strategies discussed at the workshop). Collaboration is needed across geography, as well as across sectors.
Meadows reflected on the notion of policy and practice intersection across sectors, what it really means, and what it will deliver on behalf of children and families. She highlighted several themes from the workshop discussions that were in line with the strategic direction of the health team at The Kresge Foundation:
- Defining outcomes. There is a broad range of outcomes that can be achieved at the intersection of early care and education and health. Sometimes, in trying to achieve so much, people in the field end up doing very little, Meadows said. She highlighted the need to be clear about the outcomes that the sectors are trying to achieve together.
- Unleashing capital. Kresge is working to unleash investments from anchor institutions, businesses, and other sectors and to identify new ways of financing programs that are important for the health of children and families.
- Funding and policy challenges. There was discussion about funding challenges and policy challenges. Meadows said that there are existing activities that could be leveraged for benefiting early care and education. For example, the community benefit activities conducted by nonprofit hospitals are already exploring population health and thinking about upstream activities needed.
- Communities can define the solutions. Strategically, Kresge is operating under the assumption that communities can define the solutions, Meadows said. This includes people who represent the community through their work every day, as many of the workshop participants do. Listening more closely to the community will help ensure that the foundation is making investments that will have meaning for the community, she said. Cross-sector collaborations are hard, she acknowledged, and communities that are already struggling are now being asked to participate in this collaboration. Those who have the resources, the research, and the body of talent need to determine how to be more supportive in forging these collaborative relationships. The need for leadership spans every dimension of the work discussed.
One of the goals of the roundtable is to think about how to take the best ideas and support the field in turning them into reality, Meadows said, and she shared her list of additional themes and ideas that stood out to her. First, she said, in this situation it is important to start both small and big. Leadership goes beyond training, she continued, and includes
developing leaders as advocates. The early childhood workforce is at the center of bridging equity for children, but the burden should not be on those workers alone. There are many others who could offset the burden and augment the work that early care providers are doing.
One point of intersection where both early childhood providers and health providers focus is prevention. In serving children from age 0 to 5, both sectors are seeing the impacts of poor housing, poverty, safety concerns, lack of food, and trauma on both education and health outcomes. Another point of intersection is that these children and families are struggling in their interactions with the system. There are system failures and policy failures in both the educational system and the health system that are affecting the most vulnerable children, Meadows said.
In an optimistic vein, Meadows posed several questions for thought. What would it look like if all children (regardless of race, social and economic status, or geography) had available, affordable, relevant access to the services they need to be healthy, to thrive, and to learn? What if all states were moving aggressively toward safe, affordable care, like Vermont, or created streamlined platforms to ensure that health is connected to early childhood care and learning, like Nemours? What if all of the workshop participants walked away embracing the idea that they are all working at the intersection of early care and education and health? What if the early care and education and health systems were so aligned and connected that children were experiencing the best possible outcomes that they could?
Making the Case for Children
Robert McLellan of Dartmouth Hitchcock suggested that there is a need to bring communication science to these issues. He described the challenges of convincing decision makers of a need for action, even when armed with robust evidence of a problem. Those working in the population health field need to learn how to talk to the right people, in the right language, and frame the conversation in a way that will bring results. For example, he noted the difference between having an equity conversation and an opportunity conversation with decision makers. Philip Alberti of the Association of American Medical Colleges suggested that a real focus on community engagement and partnership has been missing from the conversation. It is necessary to understand the outcomes and metrics that matter to funders, philanthropists, teachers, school board members, and whoever else in the community must be convinced to support funding. Understanding which arguments will garner support comes through
conversations and engagement with the community. Alberti agreed with Isham on the importance of understanding state-by-state policies, frameworks, and legislatures. He raised concerns about issues of racism, classism, and xenophobia that give rise to the inequities that can lead to the childhood and adult outcomes that have not been successfully addressed. He emphasized the need to engage all sectors of society in meaningful, bi-directional partnerships and to understand the metrics that matter to those sectors of society.
Meadows wondered aloud, “What if every state were like Vermont?” Richards responded that Vermont does not have it all figured out, listing some of the challenges on the path to improving outcomes. The state, she added, is struggling with the crisis of the affordability, quality, and outcomes of early childhood education as well as with various socioeconomic issues. There are deep pockets of poverty throughout the entire state and children who are at risk for a range of concerns. What can be learned from Vermont and potentially replicated elsewhere, Richards said, is the staging of a successful campaign and advocacy effort. She agreed that there is a need to identify the outcome—or several outcomes—that link the early care and education and the health sectors together, adding that the sectors can then coalesce around those priority issues and start building momentum together.
Fostering Cross-Sector Dialogue
Higgins added a question to Meadows’s generative list, asking, What if the health care industry took the leadership, and invited the early childhood community to come in and address it as subject-matter experts? If the health care community endorsed early care and education and its importance to public health and population health, it could totally change the dialogue, she said. Isham agreed and said that a dialogue between the sectors needs to draw first upon the expertise in each sector to educate the other about the options and possibilities.
Marthe Gold of The New York Academy of Medicine suggested that if the roundtable were to broaden its agenda by changing its title to a Roundtable on Population Well-Being, it would have a greater ability to bring in people from a broader range of sectors and enlarge the circles of conversations and understanding.
Funding and Sustainability
Chang reflected on the allocation of resources and emphasized political will as a key program accelerator, along with champions and leadership. She reiterated the need for sustainability, both financial and with
respect to how programs are implemented, so that they are embedded into the fabric of current existing programs and involve community capacity building.
Adding to Meadows’s list of questions for thought, Mary Pittman asked, What if there was a way to connect all the services that the families need in addition to early childhood education? What if funds from the Special Supplemental Nutrition Program for Women, Infants, and Children; Medicaid; food stamps; and tax incentives could be braided to create a pool of funds that is set aside to ensure that all of the lowest-income families have free access? She suggested a pilot program to gauge interest, pulling those dollars together to provide vouchers to the lowest-income families.
Specific Vulnerable Populations
Pamela Russo said that there is still a considerable need to address lead exposure in children, and she suggested incorporating this into partnerships between public health and early childhood. Chang also raised the issue of those children in family child care, who are among the most vulnerable children.
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