Exploring Early Childhood Care and Education Levers to Improve Population Health Proceedings of a Workshop (2019) / Chapter Skim
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3 Cross-Sector Collaboration
3 Cross-Sector Collaboration
Pages 25-46
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From page 25... ...
Krista Scott, the senior director of Health Policy at Child Care Aware, described how state child care agencies are working to make care settings healthier through professional development, settings standards, and investing in quality. Michelle Suarez, an early childhood developer with Prosper Lincoln at Nebraska Children and Families Foundation, described the development of a cross-sector community agenda to improve the health and prosperity of Lincoln, targetng early childhood i for health, wellness, and prevention interventions.
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(Session highlights are presented in Box 3-1.) NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE1 The New York City DOHMH serves a diverse population of about 8.5 million people, Askew said.
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and does not reflect any consensus among workshop par ticipants or endorsement by the National Academies of Sciences, Engineering, and Medicine. Cross-Division Collaboration on Social-Emotional Learning The Division of Family and Child Health and the Division of Mental Hygiene, both within the DOHMH, are involved in a cross-sector collaboration to integrate mental health consulting on social-emotional learning (SEL)
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; the Administration for Children's Services (the city's child welfare system, which handles EarlyLearn, an early childhood/early care and education system that includes the Head Start program)
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FIGURE 3-1 Public health approach to early childhood mental health. SOURCES: Askew presentation, September 14, 2017; Bureau of Children, Youth, and Families, New York City Department of Health and Mental Hygiene, 2017.
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This is an intensive intervention to alleviate distress and return children to healthy development. Mental Health Consultation: Accelerators, Challenges, and Community Impact ThriveNYC has been a program accelerator for the SEL program, Askew said, as all mental health consultants are funded through T hriveNYC.
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The Farm to Preschool program provides opportunities for parents and staff to purchase a box of local produce at child care enters, offers nutrition education and cooking demonstrations for adults, c and provides teachers with a curriculum to engage children in gardening. Finally, the Active Design in Early Child Care Settings program provides active design mini-grants to early child care centers located in low-income neighborhoods throughout the five boroughs.
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Head Start programs are able, through specific processes, to use Medicaid funds and private insurance funds to offset the costs of providing these services; Head Start itself is the payer of last resort. Supporting Health Equity Head Start supports health equity.
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This means, she said, that more than 10 percent of the children in OACAC Head Start -- children who had a medical home -- had not been identified as having a significant vision concern early in their childhood experience. Other screenings include hearing, dental, developmental, sensory, behavioral and mental health, nutrition status, and injury prevention.
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OACAC Head Start contracts with a local physician, who writes standing orders for all of the required screenings so that they are billable. Shinn-Brown said that Medicaid reimbursement also allows her Head Start program to fund three full-time counselors on staff as well as a full-time nurse and a part-time nurse.
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Scott noted that only one in every ten children who are eligible for federal child care subsidies actually receive them. Establishing Standards Prior to the reauthorization of the block grant, Scott said, states varied widely with regard to basic health and safety standards, and she referred participants to two Child Care Aware reports, We Can Do Better and Leaving Children to Chance, which chronicle state policies on health and safety requirements for child care.6 At the time of the reports (2013 and 2012, respectively)
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; and the incorporation of healthy active living into quality rating and improvement systems. Healthy Child Care, Healthy Communities Scott described the Healthy Child Care, Health Communities Project as an example of how Child Care Aware partners with state systems to help them include health in their state child care plans.
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Affordable and accessible child care, elements of healthy child care, and equity-rooted change levers must come together to achieve high-quality child care and healthy communities, which in turn affect the social determinants of health. PROSPER LINCOLN Prosper Lincoln is a community initiative that seeks to transform Lincoln, Nebraska, into a thriving community for people to live, work, and play, where there is equitable opportunity for all residents to have the income, education, and resources they need to be successful, Suarez said.8 Lincoln, the capital of Nebraska, is home to about 280,000 people.
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38 FIGURE 3-2 Theory of change to achieve high-quality child care and healthy communities. SOURCE: Scott presentation, September 14, 2017.
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The program capacity of high-quality early care and education programs is insufficient to meet this demand. Prosper Lincoln Strategic Plan for Early Childhood The Prosper Lincoln community agenda was developed around three priorities: early childhood, employment skills, and innovation.
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There is also interactive discussion of various topics, such as keeping families strong, parental resilience, and concrete support systems, with parents sharing their ideas. Prosper Lincoln continues to measure the outcomes of its work, Suarez said, and has metrics in place for its early childhood strategies.
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Shinn-Brown agreed with the need for champions in the community. OACAC Head Start looks for children's champions who will help move an initiative forward.
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Kindig suggested that one role for those in population health will be finding ways in which the health care system and public health can help the early care and education sector achieve its goals. There is a co-benefit to both sectors.
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A group of high school students who had learned about a continuous improvement model felt that model was important and wanted to share it, so they started teaching sixth-graders the continuous improvement model. This raises the question of how to tap into youth and engage young people in more meaningful ways, Pasti said.
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She suggested that there is a knowledge gap among those in leadership positions who make decisions about funding and financing within the state Medicaid offices, within managed care and health insurance companies, and within health agencies concerning issues involving young children. Those in leadership positions do not think about young children, she suggested, perhaps because they are not the primary drivers of cost in their decisions.
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CROSS-SECTOR COLLABORATION 45 and the mayor encouraged all of the state district agencies to take a look at it. Such population-based data can help sectors come together and share data that could add to the conversation, she said.
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