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Strategy overview

  • Increasing access to high-quality health care and education:There are a range of evidence-based supports for expecting parents and families with young children, from high-intensity interventions like home visiting programs to light-touch initiatives such as breastfeeding promotion campaigns. Generally, supports aim to increase access to health care for a mother and baby, and to provide information and resources on supporting healthy early child development.
  • Varied staffing and delivery sites: Many evidence-based supports are delivered by registered nurses or licensed social workers. Given the diversity of these supports, however, staffing structures can vary significantly. Delivery sites also vary, but most frequently include clients' homes, health clinics, and high schools.
  • Individual care, supplemented with cohort-style activities: Many programs combine one-on-one care with larger group sessions like classes, community-building activities, and milestone celebrations. Individual sessions tend to build trust and relationships between participants and service providers, while cohort activities build social capital and support, along with reinforcing key lessons from private sessions.
  • Incorporating supplemental supports: Depending on the target population, supports may include supplemental services such as mental health counseling, nutrition education, workforce readiness training, financial skills workshops, and more. Such services seek to help expecting and new parents create stable, sustainable home environments.

Multiple syntheses of rigorous evaluations find strong evidence of a range of positive health and well-being outcomes for mothers and children.

  • A 2018 research synthesis found strong evidence that early childhood home visiting can improve children’s socioemotional development, reduce rates of postpartum depression, and increase access to pre- and post-natal care for mother and child. These effects are long-term, lasting at least until the child is 7 years old.

  • A 2017 research synthesis found strong evidence that comprehensive clinic-based programs for pregnant and parenting teens can be associated with reduced rapid repeat pregnancies, increased clinic attendance, and increased completion of immunization courses for infants.

  • A 2018 research synthesis found strong evidence that breastfeeding promotion programs can increase rates of breastfeeding, with effects more pronounced when programming includes an educational component.

Before making investments in this strategy, city and county leaders should ensure it addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

Several indicators in the Upward Mobility Framework may be improved with investments in high-quality programs. To measure these indicators and determine if investments in this strategy could help, examine the following:

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

Several indicators in the E-W Framework may be improved with investments in high-quality programs. To measure these indicators and determine if investments in this strategy could help, examine the following:

  • Access to child care subsidies: Percentage of eligible families receiving assistance to pay for child care through subsidies.
  • Access to health, mental health, and social supports: Percentage of programs offering health, mental health, and social services, or staff or consultants providing infant and early childhood mental health consultation (IECMHC) services.
  • Mental and emotional well-being: Percentage of youth with mental or emotional health needs as identified by a universal screening tool.
  • Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.
  • School-family engagement: Percentage of families and percentage of teachers or caregivers reporting positive relationship quality with one another, using a tool such as the Family and Provider/Teacher Relationship Quality (FPTRQ) parent survey.

  • 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 (i.e. teenagers without parental supports). 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.
  • Create flexibility for locating client meetings: 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.

Evidence-based examples

Nine-month intensive bilingual program for child development
Stable and healthy families Kindergarten readiness
Proven
Provide education and information about breastfeeding to women throughout prenatal and postnatal care
Stable and healthy families Kindergarten readiness
Proven
Group maternity care that provides health assessments, education, and support to pregnant women
Stable and healthy families Kindergarten readiness
Proven
Comprehensive programming focused on delivering medical and social services to new and expecting teen parents
Stable and healthy families Kindergarten readiness
Proven
Culturally adapted program for Latinx parents focused on reciprocity of positive interaction between parents and children
Stable and healthy families Kindergarten readiness
Proven
Education and skills-based program for first-time expectant parents
Stable and healthy families Kindergarten readiness
Proven
Home-based program providing parents with a curriculum to build their children's cognitive and early literacy skills and social, emotional, and physical development
Stable and healthy families Kindergarten readiness
Proven
Provides home visits by registered nurses to low-income first-time mothers
Stable and healthy families Kindergarten readiness
Proven
Early childhood, family-centered intervention that takes place in schools and Head Start programs
Stable and healthy families Kindergarten readiness
Strong
Combination of high-quality early childhood education, parent education and training programs, home visiting, and other support services
Kindergarten readiness Stable and healthy families
Proven
Partnership with medical providers to incorporate early literacy promotion programming into regular checkups
Kindergarten readiness
Proven
Skills-based parent training program for caregivers of young children
Stable and healthy families Kindergarten readiness
Strong
Comprehensive, statewide early childhood initiative providing communities with funding for educational childcare, health care, and family support services
Stable and healthy families Kindergarten readiness
Strong
Offers families simple and practical strategies to help their children foster healthy relationships and manage behavior
Stable and healthy families Kindergarten readiness
Proven