1. Healthy Relationships, Healthy Children
Building a Baby Bundle

2. Healthy Relationships, Healthy Children: Building a Baby Bundle
Champions for Young Children
Workshop
August 3, 2018
Janice Gruendel, Ph.D., M.Ed.
Senior Fellow, Institute for Child Success

3. Our work for today Setting the SC context Remembering the neuroscience
What’s in your backpack?
Building a Baby Bundle
Why we do this work…

4. # 38
Part I
Setting the SC Context

5. The bottom line: We have some more work to do…
A FEW FAST FACTS
41% of all children live in single parent families
55% of children under age six live in low-income families (200% of FPL or less)
22% of South Carolina adults have reported two or more ACEs
22% (or more) young children have experienced at least three risk factors
The bottom line: We have some more work to do…

6. Part II
Remembering
the neuroscience

7. All families face some adversities, and some families face more…
Maternal depression Parent-child attachment
Domestic violence
Substance Abuse
ACES
Parental Health & Mental Health
Child Health, MH and Behavior
Family Basic Needs
Unstable/unsafe housing
Family and community violence
Not enough food to get through the month
Unstable child care
Weak social networks & social capital
Unstable work status
Needs of aging parents
Developmental delays
Health problems
Social-emotional issues
Anxiety/fear/aggression
Program absences
School suspensions/ expulsions
School performance
Adapted from ACF:

8. When Stress Becomes Toxic
NORMAL STRESS
Getting immunized; Meeting new people; First day at school. First day at work. Presenting big ideas at a public meeting; Performance evaluation
Key Concepts: Toxic Stress. Harvard Center on the Developing Child, Retrieved July 2015
TOLERABLE STRESS
Serious Illness; Death of a loved one; Frightening accident; Acrimonious divorce; Persistent discrimination
TOXIC STRESS
Tolerable stress that is NOT buffered by caring, actively-present adults (or peers). The body’s stress system activates and stays at high levels “like revving a car’s engine for hours every day.”
This causes damage at the cellular level of our bodies, impacts our health and mental health, and can be passed from one generation to the next at the genomic level.

9. The Arc of Science: Gruendel 12.5.17
Remember, adversity in the lives of young children can have dramatic consequences that can last a lifetime
The early years really matter
Intertwined cognitive and social- emotional development Executive function Self –regulation Empathy
Trauma Toxic Stress Adverse Childhood Experiences
Poverty Racism & Implicit Bias Inequity and Instability Politics…
Mindfulness
Health
Hope Healing
Resilience
We could spend an hour or a day on this slide. It is the platform on which we have build our bundle and with which we ALWAYS start. I won’t spend an hour but I hope we can come around again together and unpack it fully and richly, and learn how to use it across audiences.
I will make just four quick points. The first and last items reflect our developmental goals : Normal and normative brain development, and both internal and external states of wellness.
Remember that cognitive and social-emotional development are intertwined, experience explosive growth as the brain grown in the first years, and that while both executive function and self-regulation (managing ourselves in our world) begin to develop early but don’t burst forward until the later teen and early adult years. J JUST TALK THE OTHERS
WE CAN BUILD IT
The Arc of Science: Gruendel

10. Parents and Babies: Moms matter and dads matter, too
CLICK NOW
The Still Face Experiments

11. Part III
What’s in Your Backpack?

12. Remembering the ACES story
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13. HANDOUT ACES Yes or No. Count up the total
1. Did a parent or other adult in the household often swear at you, insult you, put you down or humiliate you, or act in a way that made you afraid that might be physically hurt?
2. Did a parent or other adult in the household often push, grab, slap or throw something at you, or ever hit you so hard that had marks or were injured?
3. Did an adult or person at least 5 years old than you ever touch or fondle you or have you touch their body in a sexual way, or try to actually have oral, anal or vaginal sex with you?
4. Did you often feel that no one in your family loved you or thought you were important or special, or your family didn’t look out for each other, feel close to each other, or support each other?
5. Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you, or your parents were too drunk or high to take of you or take you to the doctor if you needed it.
6. Were your parents ever separated or divorced?
7. Was your mother or stepmother often pushed, grabbed, slapped or had something thrown at her, or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard, or Ever repeatedly hit over at least a few minutes or threatened with a gun?
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
10. Did a household member go to prison?

14. RESILIENCE Questionnaire Yes Maybe No HANDOUT
1. I believe that my mother loved me when I was little.
2. I believe that my father loved me when I was little.
3. When I was little, other people helped my mother and father take care of me; they seemed to love me.
4. I’ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too.
5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried.
6. When I was a child, neighbors or my friends’ parents seemed to like me.
7. When I was a child, teachers, coaches, youth leaders or ministers were there to help me.
8. Someone in my family cared about how I was doing in school.
9. My family, neighbors and friends talked often about making our lives better.
10. We had rules in our house and were expected to keep them.
11. When I felt really bad, I could almost always find someone I trusted to talk to.
12. As a youth, people noticed that I was capable and could get things done.
13. I was independent and a go-getter.
14. I believed that life is what you make it.

15. About Me HANDOUT My Aces Score My Resilience Score
My current challenges
My strengths and supports today
My school climate
My classroom climate

16. What do I know? What can I know? How can I know it?
Early Trauma
Early Resilience
Current Challenges
Current Strengths
My classroom learning climate
My classroom behavior climate
HANDOUT
About the kids my classroom
What do I know?
What can I know?
How can I know it?

17. So, what about the babies?
Part IV
Building a Baby Bundle
So, what about the babies?

18. A Case Example: Bridgeport, Connecticut
City population: Nearly 146,000
Annual Births: About 1800
99.9% Free and Reduced Lunch
Bridgeport is surrounded by the wealthiest cities/towns in the state and the nation, and has the largest achievement/opportunity gaps in America.

19. A Case Example: Spartanburg, South Carolina
City population: Just over 37,000
Children under 5: About 1350
Children to age 28 in poverty: 26%

20. The Bridgeport Story
14% of 8th graders proficient in math
30% of 3rd graders reading at level
30% of entering K school ready
75% of three-year olds enter Head Start BEHIND
15% no or inadequate prenatal care
2/3rds of the city’s births are Medicaid funded
In Bridgeport’s collective impact effort, we started with the data…

21. Our BHAG: Born Healthy and Ready at 3
All Bridgeport babies born beginning in January will reach expected health and developmental benchmarks by the age of three.

22. Strong & Healthy Families Strong & Healthy Schools & Communities
Healthy Babies and Toddlers
Strong & Healthy Schools & Communities
The science says: To raise kids who are healthy and ready at 3 we need to build ‘relational health’ by investing in…
RESILIENCE

23. An Organizational Reality Check:
Real-time Data on Clients & Outcomes
CQI and Accountability
Resource Flexibility & Innovation
Internal & Cross-Agency Workforce Support & Development
Strategic Planning, Policy & Communication
Strategic Partnerships
An Organizational Reality Check:
Do we have a 21st century management and operational system at the city and state level?
Finally, we live in a rapidly changing 21st century world of operational systems and we cannot build our new goals on the basis of yellow pads and pencils.
There is a lot of incredibly hard work to do here, but we believe that America’s heath and human services is ready for the challenge and moving to build 21st century systems and operations
We talk about 6 components but there are many ways to depict operational improvement.
Data is at the center. Resource flexibility is key. Quality improvement. Workforce development, and Strategic planning and strategic communications round out our operations bundle.

24. The Bridgeport Baby Bundle Design
Supported Care and Parenting
An Army of Helpers and Advocates
Bridgeport Baby Investment Bundle
Innovation and Better Connections
Track Change. Measure Impact
OK. This is the Bridgeport Baby Bundle as I shared it with you a couple of weeks ago. I promised to go more deeply into each strategy BUT
Today let’s look specifically at the Baby Investment Bundle.
IF I were to summarize the whole Baby Bindle diesing, tho, I would would say it starts with parents and families, invites a civic and social movement behind them, makes financial investments, promote both innovation and evidence-based program and practice expansions, formalizes and celebrates partnership, and honestly tracks change and measure impact., and shares that information.
The graphic is beautiful, clever and we can say going up the elevator with some CEO or legislator. You know, the 45 second rule!!!

25. A Peek at What’s Inside Each Strategy Blue & bold=action
An Army of Helpers and Advocates
The Baby Investment Bundle
Innovation and Better Connections
Track Change. Measure Impact
Supported Care and Parenting
The Bridgeport Basics
Pre- and perinatal universal home visiting
Universal screening
Early literacy
Infant and toddler family child care
Maternal wellness (including MH)
Resilience screenings
The Bridgeport “Baby Squad”
Building champions:
Faith, pediatric, higher education and giving Sectors
Strategy #1
PLUS
Strategy #5:
Innovative Funding re Data; High wealth donor Baby Scholarships; State Medicaid re-form funding
Authentic Family & Neighborhood Engagement
Elders Rock the Babies
Top to Bottom (linking food & diapers)
Respectful service access: No wrong door and a warm handoff
National Interoperability Collaborative
Bpt Virtual Baby Data Coalition:
DSS, OEC & SDE Partnership
City DPH and hospital data Medicaid admin data

26. A Deeper Dive on Strategy #1
Innovation and Better Connections
Supported Care and Parenting
The Bridgeport Basics: Customized free website with videos and other materials
Pre- and perinatal universal home visiting: Expand Family Connects
Universal screening: New APP for parents (Sparkler with Ages and Stages), Expand pediatric developmental screening and data sharing
Early literacy: Expanding Reach Out and Read, and linking with Read to Grow
Infant and toddler family child care: All Our Kin
Maternal wellness (including MH): Expand ACES and maternal depression screening and the MOMs Partnership
The Bridgeport Basics
Pre- and perinatal universal home visiting
Universal screening
Early literacy
Infant and toddler family child care
Maternal wellness (including MH)

27. A Sample of a Deeper Dive on Strategy #1
Innovation and Better Connections
1. Supported Care and Parenting: Cross-Strategy Linkages
The Bridgeport Basics
Pre- and perinatal universal home visiting
Universal screening
Early literacy
Infant and toddler family child care
Maternal wellness (including MH)
2. An Army of Helpers and Advocates
Community hosted Resilience screenings
3. Baby Investment Bundle
Sponsors being sought for ongoing Basics’ website costs and new pediatric channel (below)
4. Innovation and Better Connections
Basics’ videos on new pediatric office TV channel and in social services offices and well-child clinics

28. CLICK

29. Hello Family: The Spartanburg Bundle
Hello Family seeks to improve outcomes for Spartanburg’s young children prenatally through age five (and their families) through a Pay for Success social financing strategy.

30. The Spartanburg Pay for Success Story
A Pay for Success project drives better outcomes by paying for positive, measurable outcomes once they are achieved – as opposed to paying for services upfront regardless of outcomes achieved. Some people also call this Pay for Performance.
ICS, May 2, 2018

33. Approximate Service Population Potential Outcome Metrics
HELLO FAMILY PROGRAM
PRENATAL - BIRTH
BIRTH – 6 MONTHS
6 MONTHS – 5 YEARS
BIRTH – 6 MONTHS
Revised: May 2, 2018
IMPACTS
BirthMatters
Family Connects
Triple P
Quality Counts
REDUCED:
Service Provider
Doula support for low-income mothers
Universal postnatal nurse home visiting
Universal parenting and family support
Early Learning Quality Improvement
Child medical costs
Parent medical costs
Child Protective Services costs
Mental health costs
Substance abuse
Criminal behavior
Remedial education costs
Approximate Service Population
350
1,500
2,100
820
Spartanburg, SC
IMPROVED:
REDUCE:
Low-weight births
Preterm births
Caesarean birth rate
NICU admissions
INCREASE:
Breastfeeding at birth
Healthy birth spacing
REDUCE:
Emergency medical
utilization, ER and
inpatient.
INCREASE:
Access to high quality
childcare
REDUCE:
Foster care placements
Child maltreatment
INCREASE:
Tentative: Family
Protective Factors
REDUCE:
Teacher turnover
INCREASE:
Kindergarten Readiness
Classroom quality
Teacher qualifications
and retention
Child and adolescent behavior
Cognitive development
Educational outcomes
Labor market outcomes
Potential Outcome Metrics

34. This is a lot of stuff to think about
WHEW…
This is a lot of stuff to think about

35. But now that we know…
Health, hope, kindness and resilience are ours to build, together for our children and ourselves
Just one word on this slide.
We have been searching around for the one image that conveys who we are, what we value and where we are going.
This is the image. For us, it speaks legions to our humanity, and to our belief our strength comes from holding each other close.

36. A Final Thought…