Real Life Stories

Louisiana Partners to Improve Early Childhood Systems

By Amy Zapata
MCH Program Director, Louisiana Office of Public Health

Louisiana, like most states, has established an early childhood state advisory council to inform policies affecting young children from birth through school entry. The 2007 Head Start reauthorization legislation was the impetus for the formation of State Advisory Councils (SACs) in many jurisdictions. Charged with advising on improvements to quality, accessibility, and coordination of early care and learning programs, legislation required SACs to have representation from the sectors that administer such programs. While broad representation from "health" was not specifically required, Louisiana’s long-standing HRSA-funded Early Childhood Comprehensive Systems (ECCS) grant initiative advisory group came to form the foundation of the state Early Childhood Advisory Council (ECAC).The 29-member Louisiana ECAC includes robust representation from health programs, including the Individuals with Disabilities Education Act (IDEA) Part C early intervention program, Medicaid, behavioral health, and the Title V Maternal and Child Health and Children’s Special Health Services programs. For the past year, I have had the opportunity to serve on the ECAC and the smaller executive committee.

A major area of focus for the council in Louisiana is supporting state efforts to create greater alignment across early care and education programs. This work includes refining the quality rating system, developing a unified professional development system for early childhood caregivers and teachers, and the development of an early childhood data system coordinated with the longitudinal system of education. Participation in the work of this priority area of the early childhood system has illuminated many opportunities for Title V and other health partners to inform and support common goals toward improved child outcomes.

The success of early care and education is inherently tied to children’s health and well-being from birth through school entry. Even for preschool programs such as Head Start, the longest-lasting gains have been shown to be among children who were healthy at the start of their lives (2012, Aizer and Cunha). Pregnancy and early childhood are recognized as critical developmental periods that impact an individual’s functioning and later health (2010, Halfon, Inkelas, and Hochstein). From improving maternal health and birth outcomes to developmental screening and early intervention, supporting the development of physical and social-emotional health are key. Louisiana’s inclusion of health as a partner in the development of a coordinated early childhood system is recognition of the critical role health plays in school readiness and beyond.

The recent evaluation of the national ECCS Initiative confirms that multisector systems-building is not simple. The evaluation findings indicate that, "…early childhood systems-building is most dynamic [where states] try to identify the areas where the greatest opportunities exist at a particular point in time and focus efforts on them while maintaining a lesser level of activities in other areas" (2012, Altarum Institute). However, the partnerships established then became a platform for "consolidating gains" as new opportunities emerge. In Louisiana, working with our state early care and education partners has been an invaluable catalyst toward establishing relationships and processes that have resulted in greater interagency coordination. These relationships and a cross-sector framework are essential to realizing true gains for the health and well-being of children.

Charged with supporting the development of health among all mothers, children and families, state Title V programs are uniquely positioned to contribute to the development and implementation of a common agenda across agencies. Doing so is a tremendous opportunity to advance Dr. Lu’s vision for Title V: to improve the quality, access, accountability and integration of systems to achieve equity in outcomes.


Colorado 9to25: Partnering with Youth to Build a Statewide System for Young People

By Anne-Marie Braga
Anne-Marie Braga, Population and Community Health Unit Manager, Colorado Department of Public Health and Environment

Audra Bishop
Youth Health Specialist, Colorado Department of Public Health and Environment

Lifelong success for young people demands coordination between all those who care for and about them. For years, Colorado has been focused on building a coordinated, comprehensive early childhood system. Using lessons learned and capitalizing on strong public private partnerships, we have recently launched its counterpart for youth – Colorado 9to25 (CO9to25). During the last Colorado MCH needs assessment, "building a comprehensive youth system" was identified by both adults and youth as a top priority. In addition, over the last five years, Colorado has focused on integrating positive youth development across the state. Positive youth development is an approach that promotes the development of skills, opportunities and authentic relationships so that young people reach their full potential. This continues to be the foundation for our adolescent health work, including our youth systems-building effort. Integrating a comprehensive systems approach for youth can provide a cutting edge opportunity to help young people and their families safely navigate the complex biological, behavioral, cognitive and social factors that impact their lives.1

Using systems thinking,2 the socio-ecological model3 and a positive youth development approach, we partnered with young people, other state and local agencies, and urban and rural community-based organizations to develop a vision and framework for CO9to25 – a collective, action-oriented network of youth and adults working together to align efforts to achieve positive outcomes for all youth in Colorado. Our vision is that all young people in Colorado are safe, healthy, educated, connected and contributing so that they can achieve their full potential. In order to reach that vision, CO9to25 strives to ensure policies, programs and initiatives across Colorado operate as a coordinated, integrated system. Once the outcomes were agreed on, specific indicators were developed with input from diverse youth and adults. To view these, click here.

Finally, after identifying the outcomes and indicators, the leadership team chose the following five broad strategies to develop a coordinated system:

  1. Mobilizing partnerships
  2. Raising public awareness
  3. Promoting best and promising practices
  4. Sharing accountability for results
  5. Promoting policy and environmental change

An action plan detailing how each strategy will be implemented is under development, but includes the department hiring two part-time youth advisors to guide and implement this work; adding our indicators to the Healthy Kids Colorado Survey (which includes the CDC annual Youth Risk Behavior Survey); partnering with other state-funded programs to leverage funds to implement local "youth system" teams; and developing and implementing an innovative "certification" system to improve the quality of youth-serving organizations, while helping youth and adults identify organizations that embody the CO9to25 framework.

We must protect and leverage the current investment in early childhood by continuing this support into adolescence. This will help ensure a sound and healthy workforce, increased civic engagement, and strong leadership among youth, while positively influencing the long-term health trajectories of adults and communities.4,5

For more information, visit

1 Bultman, L. (2006) Systems Thinking in a Changing Environment: From Planning to Outcomes. Center for Evaluation and Research, Nemours Health and Prevention Services.
2 Bultman, L. (2006).
3 The socio-ecological model supports the fact that every young person is part of a family, community and policies/systems and that each of these levels must be addressed to truly improve youth outcomes.
4 Knudsen E, Heckman JJ, Cameron JL, & Shonkoff, JP. (2006). Economic, neurobiological, and behavioral perspectives on building America’s future workforce. Proceedings of the National Academy of Sciences, USA, 103 (27):10155-62.
5 Cunha F. & Heckman JJ. (2007). The Technology of Skill Formation. Discussion Paper No. 2550. Bonn, Germany: Institute for the Study of Labor.


A Mother’s Struggle Leads to Impassioned Advocacy for Integrated Systems

By Rylin Rodgers
Training Director, Family Leadership Coordinator, Riley Child Development Center

In the world of maternal and child health, we strive for systems of care: interagency collaboration; individualized, strengths-based care practices; cultural competence; community-based services; accountability; and full participation of families and youth at all levels of the system. My personal and professional roles focus on moving closer to that ideal every day.

Early in my children’s lives, our family was immersed in a complex web of sub-specialty pediatric providers, physicians who were treating the complicated needs of Matthew and Laura and attempting to diagnosis the disease, syndrome or genetic issue that was causing their symptoms. I remember this as an overwhelming introduction to the complex world of pediatric medicine.

As I would go from appointment to appointment with a growing list of hypothesized diagnoses and often conflicting treatment plans, I distinctly remember pleading for the doctors to talk with each other and to meet with each other. My frustration hit the boiling point when I learned that the care conference I was requesting was only offered to inpatients, and as practiced did not always include the full team with which my family was interacting. In reality, my husband and I were charged with facilitating our own virtual care conference and getting to a diagnosis and plan of care would be our job alone. My blood pressure rises even now as I think of the existing community resources and programs that we were not connected with in those early years; the missed opportunities are numerous.

For our family, these rocky early experiences quickly empowered us. We knew our children, we knew our family and we would decide which medical advice would best meet their needs. As my children have grown, our family has become better able to navigate systems and services. And now, as adolescents, my children are increasingly the leading advocates in their own care. But, and the BUT is big, I have never forgotten the difficulty that the lack of coordination created. I instinctively knew it could be different and that it could be better. A system where all members of the sub-specialty team coordinated care would create better care, and likely less work. As fate – and life – would have it, being my children’s mom has led me to a life’s work focused on improving systems and services for families raising CYSHCN. And this year, over a decade after my first experiences, I find myself deeply involved in an effort at the Indiana University School of Medicine and the Riley Hospital for Children to cross silos and coordinate care. As a cross-department center slowly forms to support children with neurodevelopmental disabilities, I continually connect to my family’s experience and the experience of so many families in similar situations. My involvement is not about my family; instead it is about the systems of care that are needed for all families in our and an example of full participation of families at all levels of the system.