Neal Halfon Presentation - Using the EDI for Transforming

Using the EDI for Transforming Early
Childhood Community Systems
Presentation
Neal Halfon MD MPH
Professor of Pediatrics, Health Services, Public Policy
UCLA Center for Healthier Children Families and Communities
April Cannetto
Vice President of Community Impact
United Way of North Texas
Alex Morales
President & CEO
Children’s Bureau
March 1, 2011
First 5 California
• Strategies to improve state and local early
childhood systems
• The role of EDI and the TECCS initiative in
driving this systems improvement agenda
• How EDI can be part of a new measurement
& improvement system that can
enhance shared accountability and
accelerate early childhood systems
innovations
at the state and local level
Sub-optimal Child Development:
What’s at Stake
• School failure and additional costs due to
expenditures for second chance programs
Special education
Mental health, juvenile justice
• Di Diminished i i h d potential t ti l tto fform strong t social i l and d
family relationships
• Long-term costs in social dependency
• Sub-optimal productivity-economic, social,
• Sub-optimal health
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learn
Ready to
Birth
Early Infancy
Strategies to Improve
School Readiness Trajectories
Poverty
Late Infancy
Lack of health services
Parent education
Emotional Health
Literacy
Early Toddler
Reading to child
Late Toddler
Toxic Stress
Health Services
Appropriate Discipline
Early Preschool
“Healthy” Trajectory
“At Risk” Trajectory
Pre-school
Late Preschool
6 mo 12 mo 18 mo 24 mo 3 yrs 5 yrs
Optimizing Healthy Development
“Delayed/Disordered ” Trajectory
Addressing the factors shaping health development
trajectories over the lifespan
Age
The existing ECD service system
• Fragmented service delivery
Different sectors, (health, education,
welfare) funding streams, cultures
Lack of co-ordination - operate in silos
• Diffi Difficulty lt accessing i services i
Demand greater than services available
Narrow programmatic criteria for eligibility
Socio-economic factors limit access -
social gradient in treatment and outcomes
Age
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The existing ECD service system
• Uneven quality
Families have complex needs, often
beyond capability of any single service
Variable understanding of early years
issues
• Model of care is outmoded
focus on treatment rather than
prevention/early intervention
episodic contact
• Local community limited accountability
or responsibility
Upgrading the ECD System
• ECD systems are evolving, enhancing
functionality & performance
ECD 1.0 is about improving services
within sectors
ECD 2.0 is about connecting sectors into
more effective pathways
ECD 3.0 will be fully integrated systems
• Progress - significant but uneven
• Lots of re-inventing the wheel & slow
adoption of innovations
Service Organization
for Early Brain and Child Development
PROGRAMS
Influencing Early Brain, Child Development & School Readiness
Pre/perinatal
support
Family
Child Care
Early
Intervention
programs
Child care
centers
Family
Resource Programs
Head Start
Program
Pediatric
services
Mental
Health
services
Preschool
Parenting and Family
Literacy Programs
Child Care
Resource Programs
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Service Organization
for Early Brain and Child Development
Pre/perinatal
support
Child care
centers
PROGRAMS SECTORS
influencing Early Brain, Child Development & School Readiness
Family
Child Care
ECE Programs Health Services
Early
Intervention
programs
Family
Resource Programs
Head Start
Program
Pediatric
services
Family Support
Mental
Health
services
Preschools
Parenting and Family
Literacy Programs
Child Care
Resource Programs
Service Organization
for Early Brain and Child Development
SECTORS
influencing Early Brain, Child Development & School Readiness
Child care
centers
ECE Programs Health Services
Family
Child Care
Sector based programs
Common Agenda,
Communications
Shared outcome
Measures, Data Systems
Collaborative Systems
Improvement
Financial and
Policy Alignment
Head Start
Program
Preschool
Family
Resource Programs
Pre/perinatal
support
Family Support
Systems Building: Cross‐sector Linkage and
Integration Strategies
Child Care
Resource Programs
Parenting and Family
Literacy Programs
Early
Pediatric
IIntervention t ti
services
programs
Mental
Health
services
ECE Programs Health Family Support Child Welfare
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Health Developmeent
Creating a 21 st Century Early
Childhood System
• Vision, goals, place place-base base framework
• Leadership and participation of
multiple sectors ( health, ECE, family support, etc)
Multiple levels ( national, state, city, community)
• Cross sector pathways & innovations
• Evidence Evidence-based based & informed practices
• New integrated finance strategies
• Data that catalyzes systems improvement
and innovation
• Collaborative Improvement
&Transformation Methods
EC-CS Measurement Design: 3.0
• Measure Development Trajectories
Linked outcomes over time
• Measure Determinants of Outcomes
Availability, quality, performance of services
Developmental assets
• Measure Disparities
• Progress in Shifting Population Outcome Curves
• Link Individual, Systems, Population measures,
across sectors,
Develop a schema for Shared Accountability
• Drive Continuous Improvement, Innovation
Systematic Data Collection
For tracking Health Development Trajectories
Birth
Certificate
Pediatric Early Child
Assessment
Preschool Assessment
EDI= Early
Development
Inventory
Birth 1yr 2 ys 3 ys 4 ys
School Readiness
• Physical Wellbeing & motor dev’t
• Social & emotional dev’t
• Approaches to learning
• Language dev’t
• Cognition & general knowledge
5 ys
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Early
Development
Instrument
•104 items (10-15 min)
•Teacher’s Observation
•5 developmental domains
16 sub-domains
NEGP Concordance
What Does the EDI
Measure?
Why use a population approach?
• The EDI delivers essential information about
early childhood development for all children
in the community
• Provides the opportunity to identify and
highlight the social and environmental
factors that influence child development
throughout childhood
• Moves the focus of effort from the individual
to the community to make a bigger
difference
• Provides an opportunity to “shift the curve”
or future of a whole population and therefore
improve outcomes for many children
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Early
Development
Instrument
Extensive Validity and
Reliability data from
several countries
Percent not meeting m
expectattions
% dev vulnerable
v
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Individual linkage of EDI to
Gr.4 Standardized tests
(EDI 2001 – 2004)
Zero One Two Three Four Five
Number of EDI vulnerabilities
Results: Socioeconomic status
16
14
12
10
8
6
4
2
0
physical social emotional
AEDI Domain
lang/cog comm
Reading
Numeracy
Q1
Q2
Q3
Q4
Q5
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The EDI DOES NOT:
• Score individual children as developmentally
vulnerable or performing well
• Identify if children have specific learning
disabilities
• Recommend which children should be placed
in special education categories, who should
receive extra classroom assistance, or
whether children should be held back a grade
• Recommend specific teaching approaches for
individual children
• Reflect performance of school or quality of
teaching
Average Score on the Social Competence Subscale of the EDI, 2003
From Hertzman
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2009 snapshot of Australia’s children:
a developmental census of five year-olds
Northern Territory: 3,255
WA WA: 27,579 27 579
SA: 16,208
Tasmania: 5,916
Queensland: 55,449
NSW: 87,168
ACT: 4,432
Victoria: 61,196
Total = 261,203 children (97.5% of estimated population)
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Transforming Early Childhood
Community Systems (TECCS)
Health Development
UCLA, UWW, WK Kellogg, Cincinnati Children's Hospital
States, Counties, Communities
Sector based programs
ECE Programs Health F amily Support C hild Welfare
Common LCHD Agenda,
Communications
Share LCHD outcome
Measures, data Systems
C ollaborative Systems
I mprovement
F inancial and Policy
Alignment
Systems Building: Cross‐sector Linkage and
Integration Strategies
Systematic Data Collection
For tracking Health Development Trajectories
Birth
Certificate
Pediatric Early Child
Assessment
Preschool Assessment
EDI= Early
Development
Inventory
Birth 1yr 2 ys 3 ys 4 ys
School Readiness
• Physical Wellbeing & motor dev’t
• Social & emotional dev’t
• Approaches to learning
• Language dev’t
• Cognition & general knowledge
5 ys
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Transforming Early Childhood
Community Systems (TECCS)
Provide States, Counties, Communities with an
integrated approach to:
Engage communities to achieve school readiness
results
Measure & map school readiness outcomes
Measure & map population determinants of school
readiness
Facilitate targeted, collaborative, multi-sector early
childhood community systems improvement
process
Share learning, lessons, tools, approaches across
communities and sites
Pacoima, California
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EDI Scores
30%
25%
20%
15%
10%
5%
0%
100%
80%
60%
40%
20%
0%
100%
80%
60%
40%
20%
0%
100%
80%
60%
40%
20%
0%
Communication Gross
Motor
Fine
Motor
Pacoima Community Dashboard
December 15, 2010
Developmental Progress - % of Children Ages 1-4 Years with Developmental Risk
Problem
Solving
Personal-
Social
Socio-Emotional
High Risk Moderate Risk Expected High Risk Expected Moderate Risk
% of 3rd Grade Children Who are Proficient in Reading
Any
Social
Hardship
% Parents Reporting Reading to Their Child Daily % Children Receiving Developmental Screening
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
75%
50%
25%
0%
Dangerous
Neighborhood
% Affected by Hardship Area
Any
Health
Hardship
High Risk for
Depression
Any
Economic
Hardship
Food
Running Out
Any
Parenting
Hardship
% Parents Asked About Developmental Concerns % Parents Discussing Child Care w/ Child's Doctor % Parents Discussing Local Resources for Families
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
% Parents Asked About Maternal Depression % Parents Asked About Domestic Violence % Parents Asked About Family Stressors
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
% of Children Reached
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Little Control
Over Life
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Developmental Trajectory: Progress by
Kindergarten Entry
• Yellow percentages show the % of children who are
developmentally vulnerable
• Red percentages show the % of children with an Individualized
Education Plan (special education)
Proportion of Kindergarten Children:
Developmentally vulnerable (%)
Has IEP
Area No. Comm Phys Lang Soc Emo 1+ 2+ (%)
Arleta 105 15 10 4 11 13 30 15 10
Pacoima 397 14 9 11 11 10 26 16 7
EDI Scores
Developmental
progress ages 1‐
4 years
Measures of
real‐time
improvement
in health and
education
Reach to the
population
Pacoima Community Dashboard
December 15, 2010
% of 3rd Grade Children Who are Proficient in Reading
% Affected by Hardship Area
Developmental Progress - % of Children Ages 1-4 Years with Developmental Risk
Any
Any
Any
Any
30%
75% Social Health Economic Parenting
Hardship Hardship Hardship Hardship
25%
20%
15%
10%
50%
5%
0%
Problem Personal- Socio-Emotional
Communication Gross
Fine
Solving
Social
25%
Motor
Motor
High Risk Moderate Risk Expected High Risk Expected Moderate Risk
0%
% Parents Reporting Reading to Their Child Daily % Children Receiving Developmental Screening
100%
80%
60%
40%
20%
0%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
2009 2010 2011
% Parents Asked About Developmental Concerns % Parents Discussing Child Care w/ Child's Doctor % Parents Discussing Local Resources for Families
100%
80%
60%
40%
20%
0%
100%
80%
60%
40%
20%
0%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
% Parents Asked About Maternal Depression % Parents Asked About Domestic Violence % Parents Asked About Family Stressors
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
% of Children Reached
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Dangerous
Neighborhood
High Risk for
Depression
Food
Running Out
Little Control
Over Life
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
2009 2010 2011
Third grade
reading
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Social
determinants/
hardships
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Using the EDI to Optimize an Early
Childhood System of Services and
Supports
The Magnolia Place Community Initiative
Alex Morales
WHAT WE HOPE & DREAM…
The 35,000 children living in the
neighborhoods within the 5 square
mile/500 blocks of the Magnolia
Catchment Area, Area will break all records of
success in their education, health and the
quality of nurturing care they receive from
their families and community.
Magnolia Place Community Initiative
Catchment Area
Zip codes 90007, 90006, 90015, 90011
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A strategic plan identified four recognized
goals as having the most impact in achieving
long term outcomes for children ages 0-5
yyears.
1. Family functioning (safety and nurturing)
2. Health and well-being
3. School-readiness
4. Economic stability
Theory of Change
Points of Intervention
Social Networks
IIndividual di id l RRelationship l ti hi
s
s
Risk and Protective
Factors
Development facilitated by
Patricia Bowie and Cheryl Wold
in partnership with The
Children’s Council, The
Magnolia Place Network and
First 5 LA
Community Societal
Organizational and
Social Networks
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• Each Network member agency or individual contributes to
the vision and mission by using their own resources.
• The partners work to align their own activities within the
500 blocks towards the Initiative’s mission and strategies
through cooperation, coordination and collaboration.
• Network members form subsets of partnerships to
accomplish specific project initiatives
• The Network explicitly encourages and nurtures
innovations that could be scaled
• For example, serving as the site for testing co-location and
an integrated services strategy among multiple county
departments, in partnership with the Los Angeles County
Chief Executive Office
Goal
100% of children succeed in
health and education
Magnolia Community Dashboard
15 January 2011
Proportion of Kindergarten Children:
% of 3rd Grade Children Who are Proficient in Reading
Developmentally vulnerable (%)
Has IEP
Area No. Comm Phys Lang Soc Emo 1+ 2+ (%)
Northwest 137 12 10 17 17 7 30 18 7
"Children with parent

How the EDI Supports Our Community
Engagement Strategy
Community Survey Community Dialogues Mapping Local Neighborhoods
Introducing EDI Results
Mapping Our Neighborhoods
Creating a Community Data
Dashboard
• Shows how well a community system of services and
supports is helping young children develop and thrive
• Portrays data in ways that increase understanding and
encourage action
• Describes experiences and outcomes that represent all
young children
• Shows data in real time
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Community Data Dashboard
Developmental
progress at
school entry (EDI)
Protective factors
for families
Parent activities
with children 0‐5
% of children 0‐5
who are reached
by network
improvements
Magnolia Community Dashboard
15 January 2011
Proportion of Kindergarten Children:
% of 3rd Grade Children Who are Proficient in Reading
Developmentally vulnerable (%)
Has IEP
Phys Lang Soc Emo 1+ 2+ (%)
Area No. Comm
Northwest 137 12 10 17 17 7 30 18 7
"Children with parent

Our Community
• Population: 101,314
• School district (WFISD): 27 campuses
• Kindergarten population (1,164)
• Major industry: Manufacturing
• Educational achievement: 20% of adults over 25 do
not have HS diploma; 47% among the Latino
population
• Income data: 65% free and reduced lunch
Why Was the EDI Important to Our
Community?
• History of fragmented Early Childhood community
Apathy; lack of horizontal alignment; no central
organizational effort
• We want to be smarter about how to impact school
readiness
Targeted; visual; compare across communities and
neighborhoods
• It promotes SHARED accountability for school
readiness
Community accountability: parents, institutions,
neighborhoods and communities
Allows us to track progress over time in populations
• It will help us mobilize the community to improve school
di
How Does It Help Us Mobilize?
• Align institutional, neighborhood and community level to
vulnerabilities
Institutional
• QRIS (home and centers in neighborhood); rofessional
development (emergent literacy); Public schools
(storytelling program for parents); Language facilitator
(home; center and public school); Corporations in
neighborhood (volunteer reading program)
Neighborhoods
• Discover, connect and mobilize neighborhood assets to
improve school readiness
• Community/parent cafes specific to vulnerabilities; Asset
mapping (informal child care providers)
Community
• Social marketing campaigns; Parent engagement (Live N’
Learn)Advocacy (resident advocacy council)
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The EDI in Wichita Falls
• Implemented in 2009-2010 school year
• 100% Kindergarten campuses participated (16)
• 1,164 EDI’s were collected (79% of population were valid)
• Data was mapped to 28 neighborhoods
Defined by community residents
Strategies for Success:
Early Childhood systems focus began one year prior to
implementation
Key stakeholders were partners in the Early Childhood
Education Council
District staff, child care, licensing, Head Start, ESC
The EDI in Wichita Falls
• Effective communication with Council on EDI benefits
and EDI’s purpose as school readiness mobilization tool
not student assessments
• Strong relationship with superintendent’s office and
teachers (focused RD on teachers and principals)
• Promised continued partnerships with teachers
• Developed relationship with the gatekeeper to the
teachers: K-2 Curriculum specialist
• Individual and group meetings by campus
• Never addressed “option” of participation
• Coordinated with principals to use campus development
day for training and data entry of students
• Key district staff responsible for oversight of continuing
data entry
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Preparation for use of EDI data
• Developing and implementing plans for community, institutional
and neighborhood systems change
• Prior to EDI implementation:
• No institutional ECE focus: No focus on quality ECE outside
of federal/state funded programs; minimal collaboration,
minimal birth to three focus
• No neighborhood g mobilization work
• No community wide efforts: No CCRR, no resources or
materials for parents, no parent education programs, no
social marketing
Developed frameworks for quality ECE and for community
mobilizing
EDI provided a tangible product to generate buy-in: Expanded
momentum
Procured funds for frameworks: Align with EDI when data is
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available
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Preparation for Use of EDI Data
Mobilization Model
65
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The Institutions
Government
(HA, CDGB, County)
Higher Education
(Professional Development) Volunteer
ECE
Providers
Advocate
Fund
Ali Align
Institutional Mobilization In Action
Small Business/Corporations
(Hospitals, neighborhood
business, media)
Non-Profits
(Social services, advocacy, arts, civic)
• Discuss vulnerabilities and how to align program
components in the institutions around the data
• Targeting QRIS in pilot neighborhoods
• Developing professional development specific to EDI
vulnerabilities (neighborhood providers and community
level vulnerabilities)
• Media kicking-off one year health campaign: will target
segments to early childhood, neighborhood mobilizing
• Submitted collaborative federal grant for pilot neighborhood
to align housing authority, Even Start, childcare and
workforce development
• Submitted comprehensive systems change grant using EDI
data
Community Mobilization In Action
• Developing media and outreach campaign aligned with
EDI and windows of opportunity
2-1-1
• Developed Live N’ Learn program
Parent and child literacy engagement through daily
activities
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Neighborhood Mobilization In Action
• 2 pilot neighborhoods (targeted to the EDI)
• Neighborhood meetings with schools, teachers,
childcare providers, Head Start, Pre-K, residents,
parents, associations: Identifying connector parents
• Aligning Parent Cafes with EDI (Strengthening Families
focused)
• Hiring community organizer
• Residents are developing strategy for asset mapping
(finding informal childcare providers)
• Prosperity Hub opening (vacant property)
• Book drives
What’s Next
• Compile a school readiness population level report card
with yearly indicators
• Expand the EDI to 6 additional schools in neighboring
school districts
• Fully implement the community, institutional and
neighborhood frameworks and procure funds for pilots
and scaling
• Overlay additional data with EDI: 2-1-1; TPRI
Conclusions about the EDI
• A valid, reliable tool for measuring school
readiness
Looking Forward – challenges facing children in
school
Backward – quality and content of early
experience
• An extensive performance record,
• Becoming widely used
• Anchors a powerful measurement and
systems improvement tool kit
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Conclusions about the EDI
• The EDI Toolkit is easily implementable –
Responding to the urgency of crisis we face
Can be used to unleash the power of communities
to improve early childhood system
• EDI can be linked to future academic
performance assessment to monitor trends
and track outcomes for cohorts of children
• Provides strategic information to support
early intervention and a range of educational
innovations
TECCS
• Prototype of a ECD Community Improvement
System
• Built on a Collaborative Systems
Improvement Platform
• Designed to Catalyze Innovation and
Accelerate Rapid Improvement
• Designed to Align and Engage Multiple
Stakeholders, Across Sectors in Pursuit of
Common Outcomes and Goals
Questions ?
For copies of the slides or more
information
www.healthychild.ucla.edu
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