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Birth to Age Eight Collaborative Initiative 

State: MN Type: Model Practice Year: 2018

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Dakota County Public Health Department
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Birth to Age Eight Collaborative Initiative 
Dakota County is part of the seven-county Twin Cities Metro region. It is the third largest county in Minnesota by population. The land use is unique, with a one-third split of urban, suburban, and rural communities. The population is becoming more racially and ethnically diverse, and poverty is increasing, especially for children under age 18. More information about Dakota County can be found at www.dakotacounty.us and searching Community Health Assessment”. Learn more about the Birth to Eight Initiative by searching Birth to Eight”. The Birth to Age Eight Collaborative Initiative (the Initiative) brings essential public and non-profit community service providers in Dakota County together to assure children reach key developmental milestones from birth to age eight. The members of the Initiative include school districts; Nonprofits; and Dakota County Community Services, Public Health, and Social Services. The Initiative aims to identify more at-risk children and families early, with the vision that 100 percent of identified children meet the state proficiency reading target by the spring of third grade. The Initiative also works to connect entire families to the necessary supports to succeed. Research shows that third grade reading proficiency is strongly linked to later likelihood of graduation, economic success and socioeconomic mobility and stability. It emphasizes the importance of improving academic readiness and outcomes early in life, and breaking the cycle of poverty through greater educational attainment. Aspects of the Initiative include a collaborative referral and intentional outreach process, including an innovative consent form, legislative action, and identifying and tracking risk indicators for strategic intervention. Key developmental milestones have been identified which will calculate a risk score for children indicating a weighted level of need (red, yellow, or green). An initial analysis was successful in the application of the weighted scoring of indicators identifying children needing some level of interventions to meet developmental milestones. Upon receiving the indicator results, our collective service delivery system can then respond with precise intentionality with kids and their families. One early success of the Initiative has been the creation and implementation of an innovative and intentional referral process between the county's Women, Infants, and Children (WIC) program and local school districts. A consent form allows WIC to share family contact information with school staff, who then reach out directly and connect with parents to provide resources and services as needed. This process addresses the issue of children missing from school district census, thus not accessing early childhood opportunities. In 2016, WIC staff made a total of 364 referrals to the four participating school districts. Of these families, 75% would not have been contacted by the school without the referral and thus showing up to their first day of school potentially being at risk of not being learning ready”. This aspect of the Initiative has been so successful it was recognized by the University of Minnesota's Humphrey School of Public Affairs with a 2016 Local Government Innovation Award. In addition it was a presentation at the Minnesota Department of Health Community Health Services conference held in September 2017. The demand to learn about this process has been high; the WIC/School process and forms are being requested and shared with local public health departments throughout Minnesota. The success of the overall Initiative is due, in large part, to the commitment from each of the partners. It shows how successful we can be when we work together across sectors to protect and promote the health of children and families.
Research has shown there is strong correlation between living in poverty in childhood, third grade reading proficiency, high school graduation rates, future socio-economic status and family stability. The 2011 study By the Annie E. Casey Foundation, Double Jeopardy: How Third-Grade Reading Skills and Poverty Influence High School Graduation,” found that one in six children who are not reading proficiently in third grade do not graduate from high school on time - a rate four times greater than that for proficient readers. For children who are not reading proficiently and are poor for at least one year, the graduation failure rate is more than six times than that of proficient readers – 26%. In the four participating school districts combined, 59% of children who qualify for free and reduced price lunch (FRPL) are not reading at grade level by third grade. This cohort of children is at the highest risk for not graduating on time from high school, or for dropping out altogether. This early deficit in educational attainment predicts not only poor graduation rates, but also the subsequent likely lack of upward socio-economic mobility. An analysis of graduation rates across Dakota County School Districts shows an inverse relationship between the percentage of children on FRPL, and the percentage graduating on time. Normally, school districts use census data to connect with families, but contact information can be wrong or out-of-date, or sometimes the family is not on the census at all. This means that many families are not getting connected to crucial services and supports that could help their child(ren) succeed in school (i.e. Early Childhood Screening, Help Me Grow, preschool enrollment, Headstart). The research tells us that school readiness plays a significant role in future job and economic success. This is especially important for families living on the line of or in poverty or facing other barriers. Many of these families are already connected to Dakota County programs or services, such as the WIC program. An estimated 11 percent of Dakota County children under 18 lived in households with incomes below the federal poverty level in 2015. This Initiative improves efforts to connect children and families to schools by bringing multiple stakeholders to the same table. What is innovative about the Initiative is the intensive focus on systems alignment using existing data, as opposed to the development of new programming. The leadership support and commitment is exceptional: superintendents and county department directors are attending meetings and working to develop solutions. In the past, school districts worked independently to identify children missing from the census, and public health or nonprofits focused on specific needs (e.g. nutrition). By using a Social Determinants of Health approach and involving multiple sectors, the resulting Initiative is an innovative approach to child development and family health.
Nutrition, Physical Activity, and Obesity
Kelly Harder, director of the Dakota County Community Services Division, began formulating the concept for the Birth to Age Eight Initiative in early 2014. In October 2014, Harder convened the first meeting of the Initiative, which includes involvement and participation from both internal and external partners. A cross-system Sponsor Group exists to provide overall leadership for the project. The Sponsor Group consists of school superintendents, nonprofit CEOs, and senior managers from Dakota County Community Services Division. In addition, a Project Steering Committee, consisting of members from each of the organizations in the Sponsor Group along with other well-positioned program managers, has been convened to guide project operations. The Initiative has the strong support of the Community Services Division, has excellent project leadership provided by the Public Health Director and has been endorsed by the Dakota County Board of Commissioners. Another way in which the Initiative fosters collaboration is by facilitating new connections and building trusted relationships on many levels of the organizations involved. This happens through the Sponsor Team and Steering Committee structure, but also by bringing front line staff together to meet each other and put a face on the referral connections the project is creating. As part of the WIC pilot, for example, we are bringing WIC staff together with early childhood staff from the school districts for a meet and greet, and questions and answer session. The success of the Initiative relies on strong collaboration between the stakeholders involved, so it is important to build these relationships at all levels in order to accomplish the goals. The four school districts participating in the Birth to Eight Initiative are the ones in Dakota County that face some of the most significant challenges to getting children started early and well in their academic careers. Based on Minnesota Department of Education information for the 2014-2015 school year, the elementary schools in these districts include the highest rates of free or reduced lunches in the county (an indicator of poverty). Nine out of 10 elementary schools with highest rates of free or reduced lunches in the county are included in the four participating districts. Twelve of the 13 highest rates of limited English proficiency students in elementary schools in Dakota County are from the participating districts. The group hopes to continue expanding to other districts in the County as well as share the Initiative with other counties and cities. Initiative leadership has met with the City of Bloomington to share referral information and details about the collaborative process; Counties in Northern Minnesota and the Twin Cities Metro have requested a copy of the referral form and more information about the Initiative and successful partnerships; and Initiative leadership have presented at the Minnesota Department of Health Community Health Conference. Objectives include: 1. Establish a data process for tracking individual children by developmental progress and service access to link to school performance through grade three. 2. Create systems for identifying at-risk young children and their families to link them with supports and help maintain those connections. 3. Enroll in the pilot project a minimum of 30 children age two to four years from families participating in the Dakota County WIC Program or Dakota Health Families home visiting program. 4. Ensure that all children enrolled in the pilot program receive preschool screening. A work group of the Initiative has already identified key indicators and given them weights, to help identify children most in need of early intervention and services. These indicators include low birth weight, maternal level of education, and family under 200% of Poverty. A score of 5 or above would alert the system to yellow, while a score of 10 or more would alert to red. This would trigger program staff to take action on reaching out and providing services to get the child back on track to reach developmental milestones. An early test of these weighted indicators shows they are useful for identifying at-risk children. A referral process between the County's Women, Infants, and Children (WIC) program and local school districts has been implemented. This collaboration helps connect families to their school district by sending contact information that may otherwise be unknown or incorrect. The schools work with the families to provide resources, services, and connection to early childhood screening. An innovative consent process was also developed to aid this collaboration. Recently, a lot of work has been done to accomplish the fourth objective of ensuring children are enrolled in preschool screening. To improve the rate of three-year-olds being screened, the Initiative is tracking data across the four school districts, sharing best practices, developing common branding and communications, and promoting screening within Public Health using key messages. The work has re-framed messages around early childhood screening, to emphasize the broader opportunity to connect with all families, refer and connect them to resources, and welcome them to the school district. The costs of starting and implementing this Initiative largely consist of in-kind staff time and the cost of a consultant. The Initiative has utilized existing partnerships to reach shared goals. Successful funding by foundations provided the needed resources to hire a consultant for project management. In 2016, the Birth to Age 8 consultant worked 638 hours at a cost of $58,000 to carry out project management including meeting facilitation, resource development and grant writing for the Initiative. Current in-kind support includes office and meeting space, valued at $6,000.00; accounting/contracting services, $3,000.00; epidemiologist time, $2,400.00; administrative support, $780.00; and Birth to 8 initiative partner staff time, $14,400.00.
Objectives include: 1. Establish a data process for tracking individual children by developmental progress and service access to link to school performance through grade three. 2. Create systems for identifying at-risk young children and their families to link them with supports and help maintain those connections. 3. Enroll in the pilot project a minimum of 30 children age two to four years from families participating in the Dakota County WIC Program or Dakota Health Families home visiting program. 4. Ensure that all children enrolled in the pilot program receive preschool screening. Efforts to implement the Birth to Age Eight Initiative are continuing within the County and partner organizations. Continued evaluation shows success on multiple Initiative objective outcomes and the overall process. Data has been collected by County WIC staff, school district staff, and the Initiative consultant. Data supporting the choice of indicators is based on analyses of the Early Childhood Longitudinal Study data, both state and national level data analysis. Data for local measurement is submitted by schools to the Minnesota Department of Education, local U.S. Census Data, and Dakota County Public Health program data. An innovative referral process with the County Women, Infants, and Children (WIC) program and school districts has been very successful. In 2016, WIC staff made a total of 364 referrals to the four participating school districts. Of these families, 75% would not have been contacted by the school without the referral: 56% were new to the census and 19% needed updated contact information. After being contacted, a high percentage of the children were enrolled in preschool, received early childhood screening, and enrolled in Early Childhood Family Education (ECFE). After a successful first year of this WIC project, referral numbers began to fall in 2017. While a bit of front-loading” was expected, as previously unidentified families were referred to districts, stakeholders wanted to make sure that there weren't other issues affecting the referrals. After checking with WIC staff and district staff, some areas where clarification was needed were identified. In response to this barrier, Initiative staff agreed on a standard practice among the four districts regarding follow-up from the referral so WIC knew what to tell families to expect. A workgroup of the Initiative has already identified key indicators and given them weights, to help identify children most in need of early intervention and services. These indicators include low birth weight, maternal level of education, and family under 200% of Poverty. An early test of these weighted indicators shows they are useful for identifying at-risk children. The Birth to Age Eight Initiative team was at the Minnesota State Legislature last session sharing information about the Initiative with a Senate Birth-Five working group. Legislators have shown a great deal of interest in the Initiative's work, as it emphasizes the opportunity around enhanced service coordination along with getting more impact from existing public dollars. In addition, there has been success in receiving legislative funding and language to develop an IT solution and data sharing needs among partners. The new law facilitates: (1) the sharing of limited data necessary for community services to provide coordinated, integrated service delivery within the county system; (2) the sharing of limited community services data with education, Head Start and health provider partners to support the full range of educational, health and other well-being outcomes necessary for sustainable, positive outcomes; and (3) continued protection of notice and consent rights provided by HIPAA, the Minnesota Health Records Act and other existing state and federal data privacy regulations. The state funding to Dakota County is to develop and implement an IT solution that will evaluate the impact of a coordinated system and service delivery approach on key developmental milestones and outcomes that ultimately lead to reading proficiency by age eight within the target population. Outcome measures for the early childhood screening project have been compared over three years, both at individual district level and across the four districts combined. This includes the percent of children screened before age four over the three school years, and the number of three-year-olds on the Census for each school district. Data shows this initiative is making a positive impact for more screenings being done earlier. The overall three-year-old screening rate has improved from 30% in the 2014-2015 school year to 39% in 2016-2017 school year.
The changes brought about by this initiative are systemic and incorporated into the existing service delivery model of the partners, rather than creating additional services that add staff. Systemic changes are by nature sustainable. The data-system will be designed to minimize or eliminate duplication of data entry. While the specifics are yet to be determined with prospective vendors, the current goal is for a system to reside in the Cloud and import data-fields from multiple systems as directed by users. Changes in how information is used, collected and shared will create a more holistic and longer-term view of investment in children and what that means. Capacity limitations and potential return on investment in additional capacity may be highlighted, for example, as data-sharing and tracking are implemented. Ultimately, having access to cross-system information that creates a story for each child individually, and for disadvantaged children in aggregate, will be a powerful tool in changing the narrative for policy makers. The success of the Initiative has also been largely due to the interest and commitment from partners, the community, and other stakeholders. This will certainly be a strong factor in the sustainability of the Initiative. The cost effectiveness of early intervention is well documented, and stakeholders recognize that. With the successes seen thus far, stakeholders and increasingly invested in continuing and expanding the work of the Initiative. Additionally, other cities and counties have begun to look at implementing the work of Birth to Eight in their own organizations. This further expands the reach, the outcomes, and the potential for lessons learned.
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