what cities can do to optimize - children and families...
TRANSCRIPT
What Cities Can Do to Optimize
Children’s Outcomes
Neal Halfon, MD MPH
UCLA Center for Healthier
Children Families and
Communities
ISSUES FOR CITIES
Social Gradient :
Inequality
3
Young Children at Risk
4-6%
Severe
Disabilities
12-16%
Special Health
Care Needs
30-40%
Behavioral,
Mental Health
Learning
Problems
50-60%
Good Enough4
Sub-optimal Child Development:
What’s at Stake (focus on 0-8 year olds)
• School failure and additional costs due to
expenditures for second chance programs
Special education
Mental health, juvenile justice
• Diminished potential to form strong social and
family relationships
• Long-term costs in social dependency
• Sub-optimal productivity-economic, social,
• Sub-optimal life-long health
Higher rates of chronic health conditions
Higher costs 5
Crisis in Early Childhood in America
• Huge loss of development potential during the early
years, with both short and long term implications
• Our current approach to address this crisis has been
fragmented, piece meal and ineffective
• Addressing the crisis as a deficit services rather than
as problem in social structure, governance, and local
community capacity
• Ongoing tension between targeted strategies that
address marginal risks and universal strategies that
focus on mean of the risk distribution
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Optimizing Healthy Development
Addressing the factors shaping health development
trajectories over the lifespan
Age7
CITIES UNIQUELY POSITIONED
TO IMPROVE LIVES OF CHILDREN
Cities Creating Healthy Environments
• Have existing scaffolding (e.g. their own human/
community services, schools, libraries, parks,
recreational facilities, transportation services that all
touch children and families
• Have activated cadre of municipal leaders who want
to make their cities places where children and
families can thrive
• Despite modest resources, cities can have a
significant impact on social issues through role as
long term planners, organizers and conveners
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WHAT CITIES CAN DO
The Time is Right
• Time is right for cities to explicitly adopt a child-focused
agenda because national climate is supportive
• Cities see this is not only improving educational
outcomes, but is a strategy to improve human capital
development and community well-being
• US based philanthropies are now supporting initiatives
focusing on city-level innovation on behalf of children.
• Emerging models, best practice, and technical
assistance resources
• Living Cities; 100 Resilient Cities; Bloomberg Mayor’s
Challenge; National League of Cities; US Conference of
Mayors
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Birth
Early Infancy
Late Infancy
Early Toddler
Late Toddler
Early Preschool
Late Preschool
Age6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs
Read
y t
o learn
Strategies to Improve
School Readiness Trajectories
“At Risk” Trajectory
“Delayed/Disordered ” Trajectory
“Healthy” Trajectory
Parent education
Emotional Health
Literacy
Reading to child
Pre-school
Appropriate Discipline
Poverty
Lack of health services
Toxic Stress
Health Services
Creating 21st Century Cities
• Vision, goals, place-base framework
• Leadership and participation of
multiple sectors ( health, ECE, family support, etc.)
Multiple levels ( national, state, city, community)
• Cross sector pathways & innovations
• Evidence-based & informed practices
• New integrated finance strategies
• Data that catalyzes systems improvement
and innovation
• Collaborative Improvement &Transformation
Methods
Lessons Learned: Optimizing Early
Childhood Outcomes in Communities
• Not only about services but also about systems
• Embrace Complexity
Communities are complex, growing, developing
ecologies
• Scale the Change Needed
Big problems in complex system are not going to
respond to incremental changes
• Complex Systems Learn their way Forward
Need a Learning System to foster adaptive
change
• Systems perform better when services and sectors
are aligned and user friendly and where adaptive
innovation and improvements are normative14
City/County Level Policies & Procedures
Community Level –Organizations & Agencies
Individual Level Programs & Services
Health
Early Childhood
Child Welfare
Family Support Education
Mental Health
Housing
Economic Dev Transportation
Healthy Development
Optimizing Human Development : 3 Levels of
Complexity
Health
City/County Level Policies & Procedures: Aligned
Community Level –Organizations & Agencies: Networked
Individual Level Programs & Services : Integrated Pathway
Healthy Development
Learning
System For
Collective
Impact • Collaborative
• Inclusive
• Motivational
• Transformative
Optimizing Human Development : 3 Levels of Complexity
Child care centers
EarlyHead Start
FamilyChild Care
PreschoolFamily
Resource Programs
Child CareResource Programs
Parenting and Family Literacy Programs
MIECHV
PROGRAMSInfluencing Health, Child Development & School Readiness
Pediatricservices
Early
Intervention
programs
Mental Health services
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Shared outcome Measures, Data Systems
ECE Programs Health Family Support Child Welfare
Systems Building: Cross-sector Linkage and Integration Strategies
Sector based programs
Financial and Policy Alignment
Collaborative Systems Improvement
Common Agenda, Communications
18
HOW EDI CAN HELP ADVANCE
CITY EFFORTS
The Early Development Index (EDI)
A Community Level Index of Children’s
Health, Development and School
Readiness
10 Ways that Communities Are Using EDI
1. Engage cross-sector partnerships to improve early childhood as a
foundation for human capital development
2. Support local needs assessment
3. Inform strategic planning, resource allocation, decision making
4. Identify strategies that improve alignment of efforts across sectors
5. Increase community awareness and political support for early childhood
6. Enhance data literacy as tool for civic engagement
7. Support funding applications
8. Develop new or improved community initiatives, strategies, programs
9. Develop new strategies and programs in schools
10. Assess over time, how community’s collective efforts are impacting
children’s development
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PASADENA, CA
22
HARTFORD, CT
25
Using data to improve acess
• Op-Ed: Use of data can help families benefit from
public transit expansion
Santa Monica, CA
Citywide
Youth Wellbeing
Scorecard
Informs Cradle to Career
Master Plan
Among the on-the-ground projects
Building Blocks to Kindergarten
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Magnolia Community Initiative
Aim: All 35,000 children in the Magnolia catchment area
will break all records of success in their education, health,
and the quality of nurturing care and economic stability
they receive from their families and community. We will
increase protective factors and the reliability of
service/support systems in providing prevention and timely
need-based care.
The UCLA Center for Healthier Children, Families and Communities, under license from McMaster University, is implementing the Early Development Instrument with its sub licensees in the US.
The EDI is the copyright of McMaster University and must not be copied, distributed or used in any way without the prior consent of UCLA or McMaster. © McMaster University, The Offord Centre for Child Studies
Inset Map of Los Angeles Area2
3Rd
Mai
n
Vernon
Pico
We
ste
rn
Ve
rmo
nt
6Th
Fig
uero
a
Gra
nd
8Th
Olympic
Beverly
Venice
Wilshire
Temple
Washington
Cen
tra
l
1St
Bro
adw
ay
7Th9Th
5Th
4Th
16Th
San P
edro
Alva
rado
Hoo
ve
r
Exposition
Martin Luther King Jr
41St
Su
nset
Ava
lon
2Nd
Gle
nd
ale
Ram
part
No
rma
nd
ie
Stadium
Com
pto
n
Jefferson
Hoo
per
Hill
Nao
mi
Elysian Park
James M Wood
Hop
e
San
Jul
ian
3Rd
Olym
pic
Wilshire
5Th
Venice
Exposition
** EDI data collection is less than70% of the estimated kindergartenpopulation; interpret with caution.
0 0.7 1.40.35
Miles
EDI 2011: Children Vulnerable in the Language and Cognitive Development Domain in Magnolia Place Neighborhoods
Legend
Neighborhood Boundary
Proportion of Children Developmentally Vulnerable
Lowest Proportion
Highest Proportion
No or Few Data
101
110
10
35% 37%
22%
37%
20%
44%
33%
7%
38%
25%
21%
45%
45%
45%
Berendo
Pico Union y Rincon Salvadoreno
VecindarioPoliti
Pico y Magnolia
Magnolia
South Rosedale
USC Village
West Adams
Pico Bonnie Brae
Red Shield
Norwood
Exposition Park
Fashion District/Callejones
Broadway
South Central
% of Kindergarten Children
Vulnerable in Language
% of Parents of a Child Age 0-5,
Reading Together 2 or Fewer Days
Per Week
The UCLA Center for Healthier Children, Families and Communities, under license from McMaster University, is implementing the Early Development Instrument with its sub licensees in the US.
The EDI is the copyright of McMaster University and must not be copied, distributed or used in any way without the prior consent of UCLA or McMaster. © McMaster University, The Offord Centre for Child Studies
Inset Map of Los Angeles Area
** EDI data collection is less than70% of the estimated kindergartenpopulation; interpret with caution.
0 0.7 1.40.35
Miles
EDI 2011: Children Vulnerable in Physical Health and Well-being Domain in Magnolia Place Neighborhoods
Legend
Neighborhood Boundary
Proportion of Children Developmentally Vulnerable
Lowest Proportion
Highest Proportion
No or Few Data
1
2
3
4
5
67
8
9
10
11
12
101
110
10
Share LCHD outcome Measures, data Systems
ECE Programs Health Family Support Child Welfare
Systems Building: Cross-sector Linkage and Integration Strategies
Sector based programs
Financial and Policy
Alignment
Collaborative Systems Improvement
Common LCHD Agenda, Communications
Health
City/County Level Policies & Procedures
Community Level –Organizations & Agencies
Individual Level Programs & Services
Alignment
Healthy Development
Data, Information,
Analytics & Currency
Learning System: Optimizing ECD
“We presented to the Superintendent and her cabinet this morning and
they were blown away. Everyone couldn’t wait to get before the Board
to explain what they’re going to do next.”
Dana Fried man
The Early Years Institute
Long Island
“EDI and TECCS are helping us bring together and energize the people
who can make a difference for young children and their families. The
specific data about where children need help and the nature of the risks
they face helps us focus our efforts and agree on a unified plan of
action.”
Steven Dow
Executive Director
Community Action Project of Tulsa County
Local Leaders say….
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