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 Moving Toward Alignment of Early Childhood Systems – On-site with Guam

Dorothy.jpgBy Dorothy Cilenti, DrPH
Clinical Assistant Professor, Maternal and Child Health, UNC Gillings School of Global Public Health

Kristen Hassmiler-Lich, PhD
Research Assistant Professor, Health Policy and Management, UNC Gillings School of Global Public Health

Sharron Corle, MS
Associate Director, MCH Leadership Development & Capacity Building, AMCHP

Kristen.jpgAs part of their work with the National MCH Workforce Development Center (the Center) Cohort 2 intensive training and adaptive consultation, Guam is seeking to develop and implement a comprehensive plan for alignment of early childhood programs in several areas of their infrastructure, including public health and education systems. The project aims to analyze current systems of early childhood education, health and social services, develop common measures across systems and close gaps in early childhood programs. The project also seeks to implement evidence-based, family-centered practices in early childhood programs, reduce duplication of early childhood services, and increase enrollment and provision of early childhood systems to ultimately improve health outcomes of children from birth through age eight.

Sharron.jpgIn June, three members of the Center traveled to Guam to provide on-site training to a diverse team of 25 parents, staff members from the Title V agency, and other health, human services, and education professionals serving children in the territory. Key MCH programs included in the meeting were Project Kariñu; the Early Childhood System of Care, a program that provides promotion, prevention and intervention for children zero to five and their families, related to the development of healthy social and emotional well-being; Project Bisita, the home visiting program, which uses two evidence-based programs: Parents as Teachers and Healthy Families America; and Project LAUNCH, a Substance Abuse and Mental Health Services Administration-funded project that provides services to children and families who receive their health care at Guam Community Health Centers with a focus on developmental screening and comprehensive prevention and wellness promotion services through a medical home model.

Guam2.jpgCenter staff spent three days with the team exploring and testing methods for creating integrated service systems to better meet the educational, emotional and health needs of Guam's youngest children.

The meeting started by increasing participant understanding of the transforming health landscape in Guam and the urgency for developing contemporary workforce skills to optimize the health and well-being of children in this changing environment. Several leadership activities focused on individual and team strengths. The first day concluded with a discussion of collective impact and how this framework for action may be useful in launching systems integration efforts in Guam.

Parents shared their system support maps that described their roles and responsibilities as parents, and the resources they need on the second day; including parents in the meeting was extremely important in understanding how families experience their interaction with a variety of often disconnected service systems. Participants identified the value their agencies bring to the system, and how engaging with system partners offered significant added value. The group then developed a system map using the life course framework to lay out the services already in financial data on top. This Guam1.jpgvisual depiction generated much discussion about ways to align funding and programs to improve integration, smooth transitions between programs, and reduce duplication and inefficiency.

On the last day, participants began describing more detail about the services their organizations provide pregnant women, infants and young children through process flow diagrams. As various diagrams were shared, the group was pushed to think about ways that services could be better integrated for children and families, or organizations could collaborate to more efficiently meet their goals. After, the group was guided through a discussion about what a better, redesigned early childhood system would look like. Participants identified shared measures that they would work on collectively as they moved forward in their collaborative work. Following a prioritization exercise using an impact matrix, the participants worked on action plans for implementation.

At the conclusion of the three day meeting, Center staff and Guam leaders agreed to several next steps, including two follow up virtual trainings on strengths-based development and causal loop diagramming. The site visit and facilitation are important elements of the Center's intensive cohort model. To learn more about the Center, please navigate to http://mchwdc.unc.edu/.