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Special Edition: Title V Technical Assistance MeetingExpand Special Edition: Title V Technical Assistance Meeting
Title V Technical Assistance Meeting

 CDC Essentials for Childhood Initiative: Progress and Early Lessons Learned

By Sandra Alexander, Joanne Klevens and Renee Wright
Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

Safe, stable, nurturing relationships and environments are essential for healthy development and can prevent or buffer adverse childhood experiences, such as child maltreatment, which have serious immediate and lifelong negative consequences. 

The Centers for Disease Control and Prevention (CDC) developed Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments, a framework that outlines strategies communities can consider to 1) raise awareness and commitment to promote safe, stable, nurturing relationships and environments; 2) use data to inform actions; 3) create the context for healthy children and families through norms change and programs; and 4) create the context for healthy children and families through policies (

In October 2013, five state health departments (California, Colorado, Massachusetts, North Carolina and Washington) received CDC funding to implement the Essentials for Childhood framework using a collective impact process over a five-year period ( Collective impact is particularly appropriate for solving complex social problems that no single organization or sector can solve alone. In a collective impact process, a backbone organization (organizations with staff, resources and skills) identifies and convenes key stakeholders from different sectors and facilitates consensus around a common agenda (i.e., shared vision, goals and strategies) and shared metrics to track their progress. Work groups are created to implement the strategies; this usually requires reaching out to new stakeholders. These work groups identify what efforts must be aligned and coordinated so that they are mutually reinforcing; what efforts should be stopped; and what efforts need to be developed or enhanced to fill gaps. The backbone organization facilitates progress and coordination through continuous communication.

In addition to the five funded states, more than 30 additional  states use their own resources (i.e., "self-supported states") to participate in this initiative at different levels (e.g., participate in conference calls, webinars, meetings, actively implement the Essentials for Childhood framework). The state initiatives have been successful in bringing to the table decision makers representing several federal initiatives, such as the child care and development block grant; Head Start/Early Head Start; Maternal, Infant, and Early Childhood Home Visiting grants; the Community-Based Child Abuse Prevention grant; and Race to the Top Early Learning Challenge grant as well as philanthropic and community organizations creating an enormous opportunity to align  substantial  funds and efforts. 

By March 2015, all funded states and several self-supported states reached consensus on a shared agenda and created work groups. For example, the California vision is "all California children, youth, and their families thrive in safe, stable, nurturing relationships and environments." They proposed 10 goals that were assigned to four work groups (see table 1).

Colorado envisioned "a future where children and families thrive in places where they live, learn, work and play" and proposed to "advance policy and community approaches to 1) increase family-friendly business practices across Colorado; 2) increase access to childcare and afterschool care; 3) increase access to preschool and full-day kindergarten; and 4) improve social and emotional health of mothers, fathers, caregivers and children." Their four workgroups each focus on one of these goals.

Important lessons learned to date include the following:

  • Relationships among partners are key to success and well worth the time spent building personal connections and trust
  • The collective impact process should build on strong state collaborations and requires patience, persistence, focus, and continuous communication
  • Engaging cross-sector, executive level leaders  early is important to get their buy-in
  • Early focus on environmental factors (e.g., poverty, homelessness) that impact children is key
  • Backbone organization staff require excellent facilitation skills and the ability to let partners reach consensus

Moving forward begins the hard work of implementing the strategies to be identified by working groups. CDC and the states will continue to document the process and monitor key indicators to establish the impact of the initiative. 

For more information, visit

The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

CDC.jpgTable 1. California Essentials for Childhood Initiative:
Safe, Stable and Nurturing Relationships and Environments
Strategic Direction, Goals and Work Groups

Strategic Direction: Strengthen Families' and Communities' Capacities to Create Safe, Stable and Nurturing Relationships and Environments for Children
Goals: Identify, align and enhance the California Essentials for Childhood Initiative partners' and their stakeholders' efforts to:

​Programs and Systems Integration Work Group ​

1. Build upon families' assets to strengthen their knowledge and skills to provide safe, stable and nurturing relationships and environments for their children.

2. Achieve the highest level of well-being for families and children, with special attention to those who have experienced socioeconomic disadvantage and historical injustice, including vulnerable communities and culturally, linguistically, and geographically isolated communities.

3. Prevent child maltreatment and other childhood traumas and implement trauma informed policies and practices throughout public and private organizations and systems.

4. Improve the quality of and expand the accessibility to programs and services supporting families and children.

5. Enhance the integration of systems and networks that support families and children to improve communication, services, accountability and outcomes.

​Community Engagement and Public Awareness Work Group

6. Engage communities and strengthen their capacity to act and take leadership roles in creating safe and stable environments that support families and children.

7. Build public support and commitment (or …"public commitment and political will…") for policies and programs that promote safe, stable and nurturing relationships and environments for families and children.

​Public and Private Sector Policy Work Group

8. Embed and incorporate families and children as priorities in public policies. 

9. Increase the number and scope of private sector policies and practices that support families and children.

Shared Data and Outcomes Work Group

10. Improve and enhance data management systems that use common measurements to increase accountability for shared indicators and outcomes for families and children.