A Public Health Approach to Fostering Resilient Children and Communities
By Kim McPherson, MPAff, Senior Program Officer at St. David’s Foundation
Published August 10, 2021
We don’t remember our earliest experiences, but our bodies do. The period of brain development that occurs prenatally through preschool sets the stage for lifelong health. Seizing this window of opportunity is the central goal of the Foundation’s Child Resiliency work. While the rationale for our efforts is grounded in rigorous science, the solutions are deceptively simple: Caregivers with enough bandwidth to provide the strong, stable, secure relationships children require; families able to meet their basic needs; and communities with norms of mutual support and built environments that offer healing and protective attributes such as safe spaces, areas for social connection, and access to nature. These conditions create a recipe for resilience.
Yet, despite the importance of the early childhood period to lifelong health, until children enter public school (usually by age five), no entity or system is held accountable for their well-being. In other words, the most important period of development is the least attended to in public funding and supports. As a result, the responsibility for child well-being falls to families, but resources and information often fail to follow. The Foundation’s commitment, in partnership with our community partners who are leading the daily work, seeks to respond to and rectify this gap by providing visibility into family strengths and needs while developing the formal and informal supports that help the approximately 172,000[i] young children living in Central Texas reach their full potential.
Our funding model reflects a public health approach, using primary, secondary, and tertiary prevention to achieve population level change—all supported by efforts to promote the science explaining how the early childhood period lays the foundation for lifelong health.
Prevention. We define prevention simply: Supporting families and connecting communities to promote the strong, healthy early relationships that buffer against adversity. This means reducing sources of stress for caregivers and offering the supports and social connections that help caregivers provide positive early experiences for their children. To date, the majority of our prevention efforts have focused on increasing availability of evidence-based home visiting programs. Rigorous evaluation has shown that home visiting, when integrated within a local continuum of early childcare, reduces child abuse and neglect, improves birth outcomes, and improves school readiness. However, home visiting can’t deliver on its promise if it’s not available. Across Central Texas, home visiting capacity is extremely low—with openings for fewer than 1 in 10 high need families.[ii] By the end of 2021, we expect to have increased local home visiting capacity by at least 10% and to have ensured there is at least one evidence-based home visiting program in each of the five Central Texas counties.
Screening. Early detection improves outcomes. Screening, a form of secondary prevention, is key to ensuring early identification of risks so that interventions can be applied early, when they have the greatest impact. Well-designed screening programs identify a wide range of potential risks early, which encourages providers, whether pediatricians or social service organizations, to take a more holistic approach to the many factors affecting a family’s health. Two comprehensive screening and referral models, Family Connects and HealthySteps, have been rigorously studied and have demonstrated effectiveness in improving outcomes for young children and their families.[iii] By the end of 2021, both of these models will have a toe-hold in our region, with Family Connects available in Bastrop and parts of Travis County, and a HealthySteps pilot launched in Travis County at People’s Community Clinic. While launching these programs is a step forward, their current footprint is too small to have a population level impact. Scaling these screening programs will require additional support from public and private sources—all of whom are critical to this work.
Treatment. Screening creates an obligation to offer appropriate follow up. While only a small subset of issues a family faces will require formal interventions, those that do need a strong and accessible therapeutic web. Providers need mechanisms to connect families to local resources and the skill set to know when to refer for treatment when necessary. Progress creating a stronger therapeutic web is being made on a number of fronts, including by the Trauma Informed Care Collaborative of Central Texas, which provides expertise to local providers; Austin’s new Help Me Grow initiative, which offers a framework to organize local resources; and the Child Psychiatric Access Network, offering free psychiatric consultations to leverage the reach of trusted, but very busy, primary care providers. While these pockets of expertise are encouraging, much work remains to fully connect and leverage these new assets.
Promote the Science. Science has provided both the guidance and the imperative to create stronger foundations for the next generation. But the science doesn’t always speak for itself. Sometimes it needs translators and champions to bridge the gap between what science says and the reality of how services are delivered and systems are organized. Those champions and translators need a common language and shared framework able to bridge the multiple sectors who work with young children and their families. Tools like Brain Story Certification provide this common language and framework to help both laypeople and professionals across disciplines work effectively together[iv]. Additionally, platforms like PACEs Connection and the Pediatric Brain Health Network are also promoting the science of early brain development across sectors. If you are interested in being a part of these efforts, please check out these resources.
We now know early experiences are built into our brains and bodies, with lasting impacts on learning, behavior, and health. Brains aren’t born, they’re built. Our community’s health tomorrow is inextricably linked to the conditions that families with young children encounter today.
Promoting the Science of Early Childhood Development
But how are brains built? Twenty-first century science is revealing the mechanisms of that process, explaining how the environments we create and the experiences we provide for young children and their families affect not just the developing brain, but also other physiological systems, from cardiovascular function and immune responsiveness to metabolic regulation.[v]
While we can explain the biological mechanisms of why a child who is living in an environment with supportive relationships and consistent routines is more likely to develop well-functioning biological systems and brain circuitry, we have yet to ensure this knowledge informs the policies we adopt or the services we deliver. Unless we harness this knowledge, we risk leaving potential on the table.
Everyone in the community has a role to play. To improve outcomes for all families in our community, laypeople, practitioners, and policy makers need a common language and shared framework of understanding. Creating this shared language and framework is an important part of the Foundation’s work to promote the science of brain development. One of the best tools toward this end that we have found is the Brain Story Certification, a free online course about early brain and biological development. Using accessible language and visual metaphors (serve and return, air traffic control, brain architecture), the course helps organizations and community leaders harness the science to strengthen their work.
By explaining the core story of brain development, Brain Story Certification has prompted both big and small changes to improve outcomes for children and their families. Examples of how organizations from across North America have used the insights gained from Brain Story Certification include[vi]:
- A social service organization increased compensation for early childcare staff after learning about the critical role these staff play in laying a strong foundation for brain development.
- A childcare provider facilitated more opportunities for “serve and return” with children by changing the process for parent pick up and drop off to reduce the use of screen time after learning about the importance of back-and-forth exchanges with caregivers as part of brain development.
- A large obstetrics and gynecology practice revised its approach to taking client histories after learning about how an adult’s past experiences shape their future parenting style. Results showed 84% of patients reported feeling better cared for, better understood, and more likely to think about how they wanted to parent.
Spotlight on Any Baby Can
Here in Central Texas, St. David’s Foundation has shared this resource with our colleagues and grant partners. Any Baby Can, a larger organization leading multiple efforts related to early childhood development and caregiver support, was an early adopter, fielding a large team of 20 administrative and programmatic staff to complete the course. The organization reported that the course brought new understanding and respect for the agency’s clients, many of whom have a history of trauma, and helped the agency refine their messaging. Any Baby Can’s President and CEO was part of the team taking the certification and reflected on how the course helped center and focus the agency’s efforts:
“Everything we learned was very validating and affirming. We see it as an opportunity and a reminder about our role and our mission. It’s never too late to change the trajectory of your family’s experiences.” — Veronda Durden, Any Baby Can, President and CEO
Get Certified
We are excited to see that across Texas, Brain Story Certifications are growing, with the number of Texans completing certification more than tripling from 2019 to 2020. Additionally, those individuals getting certified come from multiple fields, helping to translate the science across sectors.
Brain Story Certifications from Texas as of July 2021
If you or your organization are interested in exploring the Brain Story Certification, we would love to learn from your work and insights. The steps to get the most out of the course are straightforward:
- Enroll in Brain Story Certification
- Form a study group, with co-workers or colleagues from another organization or field. Meet at set intervals to discuss learning. (We adults learn best when we discuss with peers and learn from each other).
- Make a schedule for completing the 19 modules. (Pace and reward yourself!)
- Capture and act on your key insights. (Create a place to record what you are thinking—circle back to these observations when you meet with your team and at the end of the course.)
- Explore the resources in the toolkit.
We would love you hear your ideas or insights. Please share them with us by emailing: brainstory@stdavidsfoundation.org
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