Supports for expecting parents and families with young children

Recognize the complex barriers to participation created by multiple disadvantages: Practitioners often struggle to reach families that are facing multiple challenges or complex needs. Wraparound support services, such as mental health support or housing assistance, should be available to address multiple forms of disadvantage. Parents and caregivers are unlikely to make progress on outcomes like mental health or knowledge of child development if basic needs are not being met.

Remove logistical barriers to participation: Programs should aim to reach participants where they are by offering programs at locations that are easily accessible and where parents may already be. Additionally, it is important that programs aim to eliminate cost as a barrier to participation, by offering financial support to cover costs related to transportation, learning materials (such as toys), and more. Leaders should offer flexibility around program timing with sessions during the mornings and evenings, or according to the needs of participants. One expert practitioner noted their new virtual program was particularly helpful for families in rural areas or those with no access to transportation.

Provide services in languages other than English: Given the success of these programs rests on effective engagement with parents/caregivers, recruiting staff members who speak relevant languages for a given community is crucial. For instance, Reach Out and Read has proved effective for parents who speak English as a second language, in part due to its use of bilingual handouts and reading materials. Leveraging translation tools to reach families speaking diverse languages is also critical to reach diverse populations with unmet needs.

Incorporate parental/caregiver voice: Support programs are most effective when they can build trust between participants and practitioners. This is particularly important for marginalized communities who may have low trust in healthcare systems and social services. Every effort should be made to center parents/caregivers in the design and delivery of support programs - recognizing their role as their child’s most important teacher and carer. This could be through an advisory board, explicit co-design approach to program activities, or via systematic feedback from participants. Empowering parents/caregivers through shaping the program supports them as advocates for their children’s needs and their own needs.

Provide culturally conscious initiatives: Programs should make every effort to be responsive to and representative of the communities they are serving, including hiring bilingual practitioners. Intentionally incorporating cultural relevance into support programs can be as intuitive as using common household items when making toys with caregivers and children. One expert practitioner championed a model whereby graduates of their support program went on to work as practitioners - ensuring that staff members reflected the community they were serving.

Children aged 0-5 and the caregivers in their life: As the primary target beneficiaries of these interventions, engagement with children and caregivers is essential to design and implement effective programs. Early education systems are often divided into separate age brackets, but parental/caregiver support should span from pregnancy onwards. It is also important to recognize that this support is valuable for carers other than mothers, with a focus that also extends to fathers, grandparents and other caregivers.

Embedded community organizations: Given challenges around access and funding, successful parental support programs often count on the wider support of local communities to get up and running. Businesses also play an important advocacy role given the benefits of child care support for labor market participation. Policymakers should consider setting up a Community Advisory Board to oversee the program and encourage partnership-working.

Local school districts: School districts can often administer, host or cosponsor parental/caregiver support programs. These partnerships can be particularly beneficial for facilitating the transition into kindergarten and longitudinal evaluations of program impact.

Health, State and Local Government partners: A range of potential referral organizations should be involved in the design of the program, from healthcare providers to law enforcement to housing associations. For instance, a home visiting program in Birmingham, AL, was championed by the County Health Department who played an important convening role in the program development.

Funders: Parental/caregiver support programs attract a wide range of funders and this is often to their benefit - both in terms of sustainability and partnership-working. Philanthropic partners can bring evaluation expertise and connectivity into pre-existing initiatives as well as financial support for a program.

Identify a clear target population: Many supports can be tailored to closely match the needs of new and expecting parents; however, those needs vary significantly. Evidence-based programs are often most effective when implemented to serve a specific subpopulation (e.g. mothers experiencing depression or significant economic challenges). Parental/caregiver support programs bring the greatest benefits for high-needs families. Selecting a focused target population will allow for a more impactful program design and more effective recruitment of clients.

Prioritize talent recruitment: Many programs require highly trained professionals to deliver a program, such as registered nurses or licensed social workers. Beyond professional qualifications, service providers should be experienced in serving target populations and be able to interact with members of relevant groups with a high degree of cultural competence.

Partner with community groups: Local schools, faith-based groups, and community-based organizations can be important sources of client referrals, boost public information campaigns, and help inform program design considerations. Local colleges and universities can also be meaningful sources of high-skill talent, particularly among institutions with social work and nursing programs. Collaborating with community groups delivering pre-existing initiatives locally or similar programs in neighboring cities can be an effective way to mitigate expensive start-up costs.

Offer location flexibility to match client preference: High-intensity programs, such as home visiting programs, often require program staff to build up a trusting relationship with a client before the client is comfortable with a home visit. To address this challenge, ensure early client meetings can occur outside of the home, such as in health clinics, community centers, or high schools. Doing so can help increase client retention; at the same time, a more public setting may allow for increased referrals and initial conversations with potential clients.

Program metrics: Several program delivery metrics give informative early indicators of progress as local leaders begin implementation. The first to track are staff recruitment and retention measures, such as number of vacancies and time to fill vacancies. The second is funded capacity utilization, which helps understand how much of the funded caseload is being filled and pinpoint any challenges around family engagement.

Family engagement and retention: The engagement of families is important to monitor over the lifespan of the program. This ranges from the proportion of referrals converted into enrollments, to attendance levels over time, to understanding at what stage in the intervention are families dropping out. Family engagement also helps program leaders understand how the trust and confidence of parents/caregivers develops through the course of the program: for instance by tracking the involvement of participants in their schools; their understanding of child development and kindergarten readiness; their openness to home visits; and the frequency of positive parent-child interactions in the home.

Parental/caregiver health outcomes: Parental/caregiver support programs can expect to deliver across a range of health outcomes, including Medicaid use, mental health, prenatal health, preterm delivery, hypertension, and substance use during pregnancy. Given many parents/caregivers supported by these programs are socially isolated, program leaders should also track social connectedness and other social wellbeing measures.

Child development outcomes: Programs should aim to measure a range of child development outcomes. This includes increases in positive parent-child interaction; decreases in language delay; proportion of children reaching numeracy, literacy and socio-emotional milestones. Where possible, leaders should seek to establish data sharing systems with public school districts to track longitudinal outcomes of children over time.

Child health outcomes: Depending on the nature of the intervention, a range of child health outcomes could be measured. This includes infant mortality rates, visits to the emergency room, mental health, the proportion of children identified as in need of services, and the proportion of children taking up referrals/early interventions recommended by pediatricians.

Parental/caregiver economic outcomes: As trust grows between parent/caregivers and the support program, program leaders should expect to see more confident participation of parents/caregivers in the local economy. This can be seen through tracking metrics like labor force participation and economic self-sufficiency.