DOCUMENT RESUME

ED 303 243 PS 017 729

AUTHOR Kurz-Riemer, Karen; And Others TITLE Way To Grow: A Proposed Plan To Promote School Readiness of Children. INSTITUTION Youth Coordinating Board, Minneapolis. SPONS AGENCY McKnight Foundation, Minneapolis, MN. PUB DATE Dec 87 NOTE 69p. PUB TYPE Reports - Descriptive (141)

EDRS PRICE MF01/PC03 Plus Postage. DESCRIPTORS *Community Involvement; Cooperation; Costs; Delivery Systems; Early Childhood Education; *Ecological Factors; Family Programs; Guidelines; Organization; Parent Child Relationship; *Parent Part.v-ipation; *Prevention; Program Descriptions; *Program Implementation; *School Readiness; Social Services IDENTIFIERS *Minnesota (Minneapolis); Prenatal Care

ABSTRACT A coordinated continuum of comprehensive, community-based services that help Minneapolis parents meet the developmental needs of their children from birth through the fifth year is proposed as a way to increase children's readiness for school. After an executive summary and brief introductory chapter, contents of the document focus on: (1) key themes related to intervention, implementation, delivery services, planning and evaluation, and other topics; (2) the conceptual framework of the plan; (3) dimensions of the plan; (4) implementation guidelines; and (5)'related issues. The conceptual framework covers such topics as school readiness, an ecological perspective, a prevention-oriented approach, targeted services, prenatal outreach services, family support, home visits, and means of enhancing the parent-child relationship. The plan for the early childhood school readiness program consists of five components: community linkages, a direct services continuum, public education and outreach, education and training, and research and evaluation. Implementation is discussed in terms of organizational structure, timeline, cost and funding. Issues concerning mobility are also considered. Six appendices provide related materials, such as an article on early prevention, and a description of Minnesota's early childhood family education programs. (RH)

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:)A PROPOSED PLAN TO PROMOTE SCHOOL READINESSOF MINNEAPOLIS CHILDREN

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BEST COPYAVAILARF Way to Grow

A Proposed Plan to Promote School Readiness of Minneapolis Children

Prepared for the Minneapolis Youth Coordinating Board by Karen Kurz-Riemer, Marilyn Larson, and Joyce Lynum Flournoy

December 1987

Made possible by a grant from The McKnight Foundation

3 WAY TO GROW

2 Minneapolis Youth Coordinating Board About the Authors

202 City Hall Karen Kurz-Riemer is an Early Childhood Family Minneapolis, Minnesota 55415 Education (ECFE) Specialist with the Minneapolis Public Schools. She taught Child & Family Studies at St. (612) 348-6995 Cloud State University for two years and coordinated the statewide ECFE pilot programs under the Council on Quality Education from 1976 to 1982. She has been a Board Members consultant to midwest Head Start programs and worked directly with children and parents. She has a Master's Mayor Donald Fraser, Chair Degree from Erikson Institute for Advanced Study in City of Minneapolis Child Development in Chicago, and is a parent of a stepson, age 16, and two daughters, ages six and three. Mark Andrew, Vice-Chair Hennepin County Board of Conunissionert Marilyn Larson is Supervisor of Early Childhood Family Education and Head Start in the Duluth Public Schools. Judy Farmer, Secretary She has been an instructor at the College of St. Board of Education Scholastica, developed and administered an employer- Minneapolis Public Schools sponsored child care center, and taught Head Start. She is currently a member of the Panel of Specialists for the Scott Neiman National Resource Center for Children in Poverty based at Minneapolis Park & Recreation Board . She has a Master's Degree in Home Economics from the University of Wisconsin- Ken Nelson Stout in Menomonie, and is a parent of a daughter, age Minnesota House of Representatives 21 and a son, age 19.

Judge Allen Oleisky Joyce Lynum Flournoy is a Regional Lead Teacher for the Hennepin County District Court, Minneapolis Public Schools Early Childhood Family Juvenile Division Education Program. She has directed a comprehensive child care program for special needs children 16 months to Donna Peterson six years of age in north Minneapolis and taught adult Minnesota State Senate vocational education classes in child development. She designed and implemented a Child Development Learning Rip Rapson Laboratory for pregnant and adolescent parents and their Minneapolis Public Library Board children. She has a Master's Degree in Child Development from Syracuse University, New York, and Sharon Sayles - Belton is a parent of an eight-month old son.

Sam Sivahich Hennepin CoUnty Board of Corimissioners

Dave TilSen Board of Education Minneapolis Public Schools

Executive Director

Richard Mammen design: Robert W. Schmitt 4 WAY TO GROW

Contents

3 Chapter 5 Executive Summary 4 The Implementation 36 Chapter 1 Organizational Structure Introduction 6 36 Timeline 37 Chapter 2 Costs and Funding 37 Key Findings 9 Chapter 6 Chapter 3 Some Issues 43 The Conceptual Framework 12 Issues Regarding The Need 12 Organizational Structure 43 School Readiness 13 Issues Regarding Mobility 43 An Ecological Perspective 14 Cost Issues 44 Prevention vs. Treatment 16 Universal vs. Targeted Services 17 Appendices A. Acknowledgments 46 Collaboration 18 Discussion Questions for Community-Based Services 18 B. Structured Interviews 51 Prenatal Outreach Services 20 C. Reprint: "Focusing on The First Two Years 22 Prevention in the First Sixty Family Support 23 Months" 52 Home Visits by D. Partial List of Existing Paraprofessionals 24 Services for Direct Service A Focus on Family Strengths 26 Continuum 56 Enhance the Parent-Child E. List of Supporting Reports 60 Relationship 26 F. Description of Minnesota's Chapter 4 Early Childhood Family The Plan 28 Education Programs 61

Mission Statement 28 Endnotes 64 Goals 28 Program Components:

Community Linkages 28 Direct Service Continuum 28 Public Education/ Outreach 33 Education/Training 34 Research/Evaluation 35 5 WAY TO GROW

Executive Summary of WAY TO GROW:

4 There is a current wave of interest in early childhood issues nationwide. Both the public A proposed plan to promote school and private sectors have been involved in issuing readiness of Minneapolis children by a flurry of recent reports, which poinrto the rising numbers of children at risk for school coordinating a continuum of failure and all its attendant social problems.

comprehensive, community-based A related issue is also receiving national services that support and assist all attention. This is the issue of prevention versus treatment. It is becoming increasingly apparent parents in meeting the develop- that school failure, juvenile delinquency, teen pregnancy, and related social problems are mental needs of their children from difficult to remedy. These problems, in turn, often lead to lifelong dependency on oursystems conception through age five. of public support.

hi 1985, the Minneapolis Community Business Employment Alliance (MCBEA) convened a task force and issued are port called Preventing Unemployment: A Case for Early Childhood Education. Its central conclusionwas that the employability of adults is related to their school performance and overall developmentas children. It recommended that the Minneapolis Youth Coordinating Board develop a comprehensive plan for the delivery of early childhood services in Minneapolis. After completing a preliminary study called Three Plus in December 1986, the MYCB sought and received a planning grant from the McKnight Foundation to develop an early childhood school readiness plan for the city of Minneapolis.

Covering a six-month time period from mid-May to December 1987, the planning process for Way to Grow involved over 200 persons representing public and private agencies and organizations throughout Minneapolis and the State, as well as selected experts nationwide. That input, combined with an intensive review of research and programming in this country and others, produced Way to Grow.

Way to Grow combines prevention and intervention for all Minneapolis families of children from conception to kindergarten enrollment, with a continuum of services based on need. It supports and strengthens the existing variety of services for children and parents in Minneapolis.

6 WAY TO GROW

The Minneapolis Youth Coordinating Way to Grow has five components: Board would implement Way to Grow through a Management Board, compoSed'of representatives from selecteci.public and private 1. Community Linkages City and State organizations; as well as members- at-large who are parents of young children. A which provides centralized information, referral, central office with professional and support staff and service coordination for families and service would carry out Way to Grow activities and providers citywide, and identifies gaps in Management Board directives. existing services; Way to Grow aims to prevent ;the 2. A Direct Services Continuum estimated 75 percent of mental retardation that is linked to adverse environmental conditions in as described above, which features a citywide early childhood. It intends to help.fainilies expansion of home visits to families of newborns deliver to Minneapolis schools a genetation of through trained paraprofessionals working within children who are prepared to succeed. Minneapolis communities; 3. Public Education/Outreach

which employs comprehensive and ongoing strategies to gain the participation of all Minneapolis families and service providers in Way to Grow, and prom )tes public education to assure the healthy development of allchildren; 4. Education/Training

which trains the paraprofessional home visitors employed by communities to offer basic support, education, screening, and referral services to families of newborns, and also provides consultation and continuing education to service providers throughout Minneapolis; and S. Research/Evaluation

which works toward effective implementation of Way to Grow and its intended outcomes of school readiness and overall healthy development of all Minneapolis children.

7 WAY TO GROW

Birthright "Ring-Around-The-Rosy" (Balloon Lovin' Child) by Phyllis J. Sloan by Phyllis J. Sloan

My Friend "ring around the rosy have a baby pocket full of posy a sweet caressing ashes ashes momma-missing baby we all fall down" a soft Johnson&Johnson broken children smelling baby wounded children a slow to grow bits and pieces of little hearts full childhood baby beat fast a balloon lovin' child on guard at all times rock-a-bye your baby to sleep each night broken children not knowing how let him nurse of your breasts to play carefree "childlike" lounge in your lap scream: "someone's always messin' with me' read early to him and strike out with cobra's venom sing to him melodies----warm tunes flinch at extended hand and whisper of your love to him victims of victims society's :outcome ,products results bring to earth a gentle child filled with wonder broken children amazed by mysteries ring 'round us competent for challenge wounded children fed physically and mentally of every age with nature's finest

My Friend have a baby hurry bring to us a child

BIOGRAPHICAL NOTE:

Phyllis J. Sloan is director of a Special Needs A collection of her poems was published in an 1987 Child Development Center for low-income families in anthology entitled "Three Women Black". Ms. Sloan Minneapolis, Minnesota. She is also an author and editor attended Minneapolis public schools and received her with Guild Press Publications in Robbinsdale, Minnesota college education in Chicago, Illinois. 8 Chapter 1 WAY TO GROW

Introduction

7 The preceding poems illustrate stark skills, are administered in the spring at the contrasts of childhood and parenting. completion of the school year. In 1986, 19 "Birthright" talks about a planned for, longed for percent of kindergarten students citywide failed child, fed "physically and mentally with nature's the benchmark test. Thirty-five percent of finest". "Ring-Around-the-Rosy" mourns the minority kindergartners failed, compared with "broken children" who are "Victims of victims". seven percent of white students? It isn't hard to predict which type of child is likely to to be more competent and prepared to Minneapolis is lucky. Its public school enter the public school system at age five. and city problems don't match the severity of those of many other large cities. Yet the Indeed, there is an increasing body of problems are no less real or painful by being less research which points to formation of early widespread. parent-child attachment as being more predictive of social competence than any other factor. Social competence, or the ability to take risks and solve problems in a wide variety of situations, is "Way to Grow is based closely tied to a sense of self-esteem, or pride in oneself. For a child, learning to be proud of who on the belief that you are requires the encouragement and support of one or more caring adults. Parents who feel the raising cf our children overwhelmed or powerless themselves will find it most difficult to support, encourage, and be is a public trust vital sensitive to the needs of their children. The same will be true of child care providers if they feel to our city's future. " overworked, underpaid, and generally discontented.

In the Minneapolis Public Schools, Minneapolis is also fortunate in that it has kindergarten teachers are becoming alarmed at the a wide variety of human service agencies. There increasing numbers of children who are coming is a strong progressive tradition in this city and to school functioning less like 5-year-oldsan 3- state. Yet some experts argue that if services are year-olds, and insecure 3-year-olds at that. not integrated and coordinated, much of the effort These children are easily frustrated, lack spent is lost in fragmentation, in not reaching the persiStence in learning tasks, are noncompliant or most needy, and in losing people in the cracks defiant with teachers and other children, and and gaps between services. generally exhibit low self-control and self- esteem. Children who are oriented to failure tend This notion provided the impetus in to be unwilling to accept the risks and December 1985 for the formation of the opportunities that formal learning presents. Minneapolis Youth Coordinating Board (MYCB). Created by a joint powers agreement Nationally, it is estimated that 30 percent among the City of Minneapolis, the Minneapolis of children are facing major risk of educational Public Schools, Hennepin County, the failure.Children who experience failure so Minneapolis Park and Recreation Board, and the early in the formal school system are most Minneapolis Public Library Board, the MYCB's certainly at risk for many social ills later, purpose is to maximize developmental including juvenile delinquency, chemical opportunities for the nearly 88,500 children and dependency, teen pregnancy, unemployment, youth (ages 0-20) residing in Minneapolis. and potential lifelong dependency. At, about the same time the MYCB was In Minneapolis, kindergarten benchmark being created, the Minneapolis Community tests, which are designed to measure student Business Employment Alliance (MCBEA) achievement of basic language and mathematics concluded a task force study of the relationship 9between early childhood development and-the WAY TO GROW

later employability of adults. Its findings were interviews and from the literature search. In published in a December 1985 report called most cases, opinions expressed in the interviews Preventing Unemployment: A Case for Early coincided with the findings in the literature. Childhood Education. MCBEA's central conclusions were that high quality early There was a crucial third step in this childhood development programs improve future planning process. Once a skeletal first draft was employability for low-income children, and that developed in early August, reactions were sought this community must address employability from frOm the original interviewees, as well as from birth. A major recommendation of the report was additional professionals in Minnesota and other that the MYCB assume leadership in developing parts of the country. Thatrfeedback was a comprehensive policy plan for the delivery of incorporated into a second draft of the plan, early childhood services in the city of which was presented in October for reactions Minneapolis. through a large group meeting and a mailing to over 200 persons. In November 1986, the MYCB contracted with Scotty Gillette to *pose a This report, then, is the result of a sincere means of connecting existing resources for better effort by many-individuals whose opinions were service delivery to Minneapolis children prebirth graciously and thoughtfully given. (See to age three. Her report, Three Plus, created the Appendix A.) It represents the best thinking of rationale and impetus for an MYCB request to the many creative minds: academicians, service McKnight Foundation for a six-month planning providers, policy makers, and recipients. While grant to develop an early childhood school there was not consensus on every point, there readiness plan. The planning grant was were major themes that surfaced time and again. approved in late February 1987. Karen Kurz- These themes are presented as "Key Findings" in Riemer was hired as a consultant by the MYCB Chapter 2. Chapter 3 provides the conceptual and began work on this plan in mid-May 1987. framework and rationale for Way to Grow. 'Chapter 4 describes the plan itself. Further The first step in the development of the details related to implementation of Way to plan was to conduct structured interview Grow follow in Chapter 5. Issues which (Appendix B) with over 100 individuals emerged or are likely to emerge in relation to representing local, metropolitan, and state Way to Grow are discussed in Chapter 6. agencies that serve or have an impact upon Minneapolis families. The purpose of the Way to Grow is based on the belief that interviews was to begin to identify: (1) barriers the raising of our children is a public trust vital to to agencies accomplishing their organizational our city's future. All families need support and missions, (2) success factors relative to assistance to raise their children well. The accomplishing agency missions, (3) the target foUndation of attachment, parent-child population for a comprehensive school readiness interaction, and overall mental and physical plan, (4) the critical elements of such a plan, and health laid down between the time of conception (5) outreach strategies to ensure the success of and age six will determine the degree of each the plan. Most of the interviews were conducted child's school readiness. And school readiness, in small groups, allowing for discussion among in turn, lays the foundation for competence and the participants and contributing an added success in school and in life. dimension to the infomiation received. Let us act on the belief that all citizens Concurrent with the interview process, an have the same "Birthright"--the right to be extensive literature search was undertaken to find lovingly cared for as children, so that as adults the latest thinking, research, and model programs they can provide the same legacy of caring to around the country and elsewhere in the world. children of their own. Way to Grow is a synthesis of information coming from the structured 10 Chapter 2 WAY TO GROW Key Findings

Bloom from the University of Chicago suggests 1. The developmental process of that 50 percent of intelligence measurable by age 17 is developed by the time a child is four years school readiness begins at concept- old. Up to 80 percent i§ developed by the time a ion. Efforts to promote school child is seven or eight.Although research indicates that traits such as temperament and readiness must also begin here. activity level are biologically determined, it is becoming increasingly clear that many characteristics are shaped by the people, objects, If school readiness is defined broadly to and events in a child's environment. The include a child's intellectual, physical, social, and General Accounting Office estimated that 75 emotional preparedness for kindergarten and first percent of mental retardation can be attributed to grade, the process of developing readiness adverse environmental conditions duringrearly begins at a child's conception. It follows that childhood, and thus may be preventable? school readiness efforts should begin with promotion of early and regular prenatal care in Ongoing opportunities for screening and order to prevent low birth weight. Low birth assessment of overall development from birth are weight babies account for 60 percent of all deaths the starting point for families and service before one month of age and 20 percent of deaths providers to address physiological or between one month and one year.In environmental factors which might affect school Minneapolis, the overall infant mortality rate readiness. The provision of a continuum of (number of infant deaths per 1,000 live bixths) services based on need from so-called "low risk" jumped from 9:2 in 1985 to 12.5 in 1986.For to "high risk" is also essential. infants who survive the fir: t year of life, low birth weight is associated with cerebral palsy and other developmental disabilities. Premature, low birth weight babies are ten times moreikely to be mentally retarded than normal infants. 3. The promotion of schoql readiness should be approached This city's future is dependent upon the healthy development of its children. Therefore, comprehensively through ongoing information oittile importance of prenatal care coordination of existing prevention and other positive practices, that will promote healthy development must be aggressively and intervention services in presented in education campaigns aimed at Minneapolis. raising public awareness in the general population. Barriers to obtaining early and regular prenatal care must be examined and Although there are many services addressed. available in this city, most respondents indicated a need for improvement in the area of coordination, collaboration, and referral among these services. To maximize the effectiveness of 2. Intervention to resolve or existing services, it is critical that public, 31. nonprofit, and for profit agencies find a vehicle reduce developmental risks should for working more closely together, as opposed to be offered as early as possible. competing with each other. Occasionally, innovative agency partnerships will produce needed programming without requiring new Just as in the medical field where the resources. Where the need for new resources is earlier diseases are detected and treated, the better clearly indicated, the united front collaborating the long-term prospects of full recovery, early agencies can present in advocacy efforts will be intervention with children at risk for more effective than piecemeal, multiple, and developmental problems is critical. Benjamin often conflicting requests for new funds. 11. WAY TO GROW

10 To accomplish this elid, interagency collaboration must accommodate a process for 4. Whenever possible, services planning which will enable staff people to work should be located within the torther more productively and purposefully. Also important is an ongoing process for communities in which families of evaluation, which will improve service delivery, young children reside. as well as measure service outcomes.

The preference for neighborhood based services was expressed frequently throughout the 6. planning process. Families are more likely to Professionals and trained utilize services offered in conveniently located, paraprofessio 21s should offer home familiar locations. Although some highly visits for support, education, specialized services are only feasible when offered at a central location, many providers informal assessment, and service could better serve families by decentralizing as referral to ail families of newborns. much as possible. Community locations for a variety of family services more closely approximate natural helping systems of kith and There seems to be strong agreement that kin, which have been weakened by the high the birth of a baby initiates upheaval in all mobility of -both young adults and their parents. families. What makes a difference in the outcome are the resources a family has to cope It is particularly important to locate child with.this major life event. :A 15-year-old single care sites close to homes or workplaces in order mother is likely to face more difficulty in to strengthen the parent-provider partnership adjusting to her new baby, for example, than a which is essential for the healthy development of two-parent family of adults who are reasonably young children. well educated and financially stable. Yet, one cannot assume that the latter family will cope well, and that all helping resources should be channeled to the former family. Statistics on the 5. Any system that intends to inc. Bence of child abuse and developMental and learning disabilities remind us that childrearing promote collaboration of public, problems are not confined to low income nonprofit, and for profit agencies families. must assure adequate planning and New parents and their infants are all evaluation, both preliminary and vulnerable, and all can benefit from basic support ongoing. and assistance. In most European countries, home visits area routipe service provided to all families of newbornsThere is some evidence Although in theory, if agencies work that initiating home visits before birth for high more closely and cooperatively together, their risk families can be even more effective. See services will be more effective and their work Appendix C for a discussion of prevention more rewarding, things are not this simple in services for the general population from the National Governors' Association. practice.Each agency has its own entry criteria, operating procedures, and internal politics. Until providers strive to offer an accessible continuum of services through close coordination with other providers, Inwever, many children will continue to fall through the cracks,and never reach their 12 developmental potential. WAY TO GROW

11 decisions on families. Integrated social programs must work toward total family competence 7. All family service programs through initiatives such as welfare reform, health should be designed to identify and and child care benefits, and parental leaves. build on the strengths of the family The need for these major social reforms and individual family members, must not paralyze us, however, and keep us from undertaking less sweeping approaches to rather than focusing exclusively on prevention of social problems. Dr. James deficits. Garbarino of Chicago's Erikson Institute puts it well:

A cornerstone of the sense of We cannot wait for all the big problems competence, or ability to meet challenges and to be solved before we tackle smaller solve problems, is a sense of self-esteem, or ones.One way to deal with the issue of pride m oneself. Self esteem is nurtured when prevention is to take both positions. We children are loved unconditionally by their can continue supporting programs that parents and/or caregivers, and when they are help children and families while we work recognized for their individual strengths and toward greater social reform and a better achievements as they grow. society. Children cannot wait./

Similarly, programming that reinforces The research and other literature the strengths of families v, ill support the underpinning the key findings discussed above development of parent-child attachment, will be are reviewed in Chapter 3 of this report. sensitive to ethnic/cultural and other differences, Supporting reports are listed in Appendix E. and will promote the self-esteem and competence of all family members. Parents who feel competent will be better able to support the healthy growth of their children. And children who have a strong sense of self-esteem and competence will be ready for the formal learning experiences of school, as well as the challenges beyond.

8. Any collaboration to promote the healthy development of young children must take into account the primary needs of families for food, shelter, clothing, employment, health care, and child care.

Parents who are unable to provide for their own or their children's physical needs will find it most difficult to promote the healthy development of their children. It is therefore imperative that policy makers think 13 comprehensively about the impact of their Chapter 3 WAY TO GROW The Conceptual Framework

12 weight babies (less than 5.5 pounds) in The Need Minneapolis is 6.8 percent. The black rate, however, is 11.7 percent. These percentages Statistics on family disorganization and have remained consistent over the last ten years. dysfunction are sobering. In our industrialized At this rate, it is concluded that Minneapolis will western nation, one would expect children and not reach the Surgeon General's goal of families to be better off than they are. We have decreasing the rate o° low birth weight babies to not been successful in eradicating high infant five percent in 1990. mortality or child maltreatment rates.' Out of the 6,299 babies born in Minneapolis in 1984, the Minneapolis trends are similar to national Department of Health estimates that trends, where poverty rates are higher than they approximately 30 percent (1,890 infants) could have been for more than 20 years. Poor families be considered "at risk ".The failure rate for the have become poorer, and white children are Minne polis kindergarten "benchmark test" in beginning to catch up to black children in risk 1986 was 19 percent. Minority failure rate was factors.Nationally, low birth weight incidencs 35percept,as compared to 7 percent for white has improved only slightly in the last 35 years.° students.3

Although the Minneapolis population is 38 percent of Hennepin County's total "Our main problem is not population, the Minneapolis portion of Child Protection Services portion in 1986 was 65.3 our lack of knowledge about percent of the county total. The Minneapolis portion of Child Welfare Services caseload was how to help families; it is 58.9 percent. From December 1975 to June 1986, the monthly AFDC caseload in the need for commitment to Minneapolis increased by 1,330 cases; Hennepin county's monthly caseload decreased by 119 the provision of high-quality cases. The Minneapolis share of Hennepin County's AFDC caseload in 1975 was 65.7 family services." percent. In 1986, it was 75.3 percent.4

Since 1981, the proportion of births to unmarried mothers in the city has increased to This is in contrast to ten western European approximately one in three. Specifically, 80 countries, all of whom have lowered their low percent of American Indian, 70.3 percent of birth weight rates and are doing a better job at black, 20.9 percent of white, and 20 percent of infant survival? Asian/Pacific Island births were to unmarried women in 1985. How have we arrived at this point--a nation with tremendous technological That same year, the proportion of sophistication that seems stymied by an inability Minneapolis women receiving prenatal care in the to solve some basic social ills? As a nation, we first trimester of pregnancy was only 71.3 have given "lip service" to concern for the plight percent overall. These rates range from 78.2 of children since the early 1900's. Between the percent for whites down to slightly over 42 New Deal initiatives of the 1930's and the Great percent for American Indians and Asian/Pacif Society Programs of the 1960's, programs in Islanders. This does not compare well with the maternal/infant health and nutrition, early Surgeon General's goal of ensuring that 90 childhood education (Head Start) and income percent of all pregnant women ob care within supports tuvomen and children were the first three months of pregnancy. instituted."' But they have not been able to keep pace, with the numbers of children in poverty and Currently, the overall rate of low birth at risk. 14 WAY TO GROW

13 One way to explain the plight of children is to blame the family. Ours is not the first generation to lament the breakdown of the School Readiness American family. Hareven reports that for several generations back in our histqry, the School readiness is a term that implies demise of the family was predicted." The certain prerequisites for school entry besides family is under siege today, however, in proper enrollment age. Being ready for school situations where environmental and political means being ready to succeed at school work. It forces havexected bathers and posed means meeting certain developmental attainments difficulties." that are considered to be crucial to school success. Being "not ready" means being at risk In addition to societal conditions, for failure. however, there are also strong belief systems that operate against the family today. Current belief For many reasons, readiness for formal systems grew out of the 19th century transition to learning is necessary to guarantee success in industrialization and urbanization. This transition school. Today, more than ever before, there is removed economic roles from women whose pressure from several arenas to increase daily labels had been essential to family survival educational standards and requirements." and glorified motherhood as a full time career. Children who enter school unprepared to meet The revised expectations of parenthood that the challenges are indeed starting with two strikes followed have created tensions between the ideals against them. and the reality of family life. Myths have grown up around the family as priv ite, independent, and Because school success is considered to self-sufficient. From the pre-industrial family, be so important in our culture, both in itself, and who often took in either relatives or strangers as as the means to later life success, one of the boarders who participated in the family economy, major tasks of parents is to ready their children we have moved to a "glorification of the home as for the school experience anflbto continue to a retreat from the outside world" and placed an facilitate theirachievement. What does the "exaggerated gmphasis" on nurturance, intimacy, "ready child" look like? An even more basic and privacy. question is, what do the parents of the "ready child" look like? There are certain things that The emphases on privacy and on total parents do with and for their children that parental rights have combined to isolate the promote school readiness and eventual schI family from needed social support systems.14 success. According to Garbarino and Asp, the We need to rethink these emphases and to following conditions help to assure children a consider the idea that while parents have primary good start: responsibility for the well-being of their children, the community also has a responsibility, that is to Parents communicate that school is a support the parents. If indeed we could shift in positive, necessary experience by our beliefs from that of the self-sufficient family displaying a use for written materials and to that of families connected to each other by by being motivated themselves to look community and other social supports, then it competent in the eyes of the school. This follows that we could commit to the,spcial and involves modeling reading and language economic well-being of all families.'As fluency, as well as valuing schooling. Kaplan explained: "Our main problem is not our The parent-child relationship includes lack of knowledge about how to help families; it opportunities for parents to convey a is the need for commitment to, he provision of regard for "academic culture," by high-quality family services."° communicating and encouraging conceptual language in problem-solving and manipulation of symbols. Parents' interaction styles with their 15 children teach and encourage the pro- WAY TO GROW

14 social behavior needed to adapt to school: whose roots lie mainly outside the child's mainly delay of immediate gratification capabilities to do successful school work,means and accommodation to rules and looking at ti .e family and the school and expectations. Style and manners are "measuring the fit." Much can be done to help crucial to school adjustment. the family adjust to school expectations. And much can be done by the school to adjust The other prerequisite for school success expectations to meet the culture of the family.h.3 is, of course, a developmenjly sound child, or an "undamaged organism". It is important that children be free from neurological and psychological damage or disturbances. It is the above authors' contention, however, that most An Ecological Perspective children are capable of school success, and that failure comes more from a lack of motivation, The overriding theme in the conceptual support, and appropriate school-like behaviors. framework is that of an ecological approach toward defining need, desired outcomes, and One can infer from this information, then, services implemented to affect those outcomes. that to support the family in readying its children The development of this perspective began with for school means to offer the following the work of Dr. Urie Bronfenbrenner. His assistance: model of the human ecosystem clearly sets forth the need to consider the organism, not alone, but Early screening of children to prevent as part of an ever-widgqing ring of interactions and/or offer early treatment for with other organisms. Bronfenbrenner's neurological or psychological damage. model is useful because it helps us to maintaina Support and information for parents that developmental perspective when defining needs helps them to provide a cognitively of families and children. It allows us to broaden stimulating and pro-social home the concept of services to include working to environment for their children. change those systems that are most harmful to A program of transition to kindergarten parents as they try to meet the needs of their that helps children learn to function children. within school expectations and helps parents feel comfortable at school and What is an ecological perspectiveas with school personnel. applied to families and children? It is a broad view that looks at the child within all the These recommendations are consistent developmental contexts that impinge on that with those ,of the Governors' 1991 Report on child's development: immediate family, extended Education." In the report from the Task Force family, friendship groups, neighborhoods, on Readiness, parent education is mentioned in schools, communities, and larger configurations two arenas: assistance to first-time parents and of society. These are "regularly occurring information regarding successful parenting environmental settings that can affect practices. development bLpresenting risks or opportunities".43 It is an established fact that low income children are educationally at risk. However, This view includes an observation of the adequate academic stimulation can help ovAcome interactions between the child and the subsystems some of the debilitating effects of poverty." or contexts in which that child develops. Do Therefore, it makes sense that a readiness effort parents understand the child's needs? Is there an combine both assistance to parents in providing extended family that is supportive? Is the adequate academic experiences and programs for neighborhood safe for children? Does the mother children which augment home experiences. have a friend or two she can call when she needs to talk? Is the neighborhood school attuned to Looking at school readiness as a problem the cultural and economic conditions that exist for WAY TO GROW

15 children? Are there child and maternal services the community by forging connections with those offered in the community? Are there institutions such as school, church, health care, playgrounds or parks close by? The result of all or child care that exist to offer needed services29 these forces acting on the child is termed If these connections are strong ones, and positive "environmental press," which refers to the for the family, the child is developmentally combined influences that occur from all of the enhanced. If parents are unable to forge those child's environments. That press, combined links, the child's development suffers. with the child's own inner resourcek,is what Garbarino and his colleagup1 offer the home- shapes behavior and development.B° school link as an example. 3u If parents are able to orient the child to the world of school Why is an ecological perspective useful? (academic culture), the child will be able to take It is useful as a model because it helps us to make full advantage of the school's services. For sense out of the forces that affect children. It some families, then, the appropriate intervention helps us to understand why, in identical point is here: providing services to help the economic conditions, some families thrive and family forge positive connections to institutions. help their children develop optimally, while others seem unable to rear successful children. It The larger community can provide either keeps us from putting all the blame for poverty stressors or support to families. A good and/or debilitating lifestyles onto the victims, neighborhood "enhances development by because it is clear to see that environment plays a providing the kind of multiple connections and big role in producing those conditions. And it multiple situations that permit children to make helps us to design programs and services for the best use of their intellectual and social families that deal with envy conmental equipment. It gives them a sense of familiarity impoverishment and systems change. and belonging, a territorial base. A strong neighborhood also offers a sense of security and When designing services for families peace of mind for the parent, feelings that using the environmental perspective, we place the translate into a more relaxed and positive stance child in the middle of an ever-widening ripple of toward the task of ctild rearing and toward the environmental contexts. Alone, the child cannot child in particular ".31 Especially in low income survive. So, the smallest target group to neighborhoods, where parents are without the consider is the family. Everything that happens resources needed to transcend location, the to small children is filtered through or mediated availability of support and of natural helping by the family, most often a parent. To have an systems is crucial. Here then, is another level of effect on the child's life necessitates affecting the intervention, with efforts to enhance family. Therefore, the family, rather than the neighborhood services in order to increase child, is csidered to be the appropriate target of habitability. services. Finally, there are societal forces at work The family's link to friends, extended that serve to undermine the family in its family, and neighbors is also a possible target. If childrearing role. Some of the most damaging there are too few participants in the child's forces are: (1) a tacit social acceptance of immediate world (for example, an isolated single domestic violence; (2) an emphasis on mother) there may be insufficient nurturance and individualism; (3) a tolerance of sexism and feedback to keep the parent-child relationship a racism;40 (4) an emphasis on material gain at positive growth-producing one. Or, the available all costs.An34 ecological approach works to adults may not be "free from drain" NA thus be change the "big picture" as well as the child in the unable to offer the necessary support. h° If family. Intervention at this level works at parents lack nourishing relationships with other widespread public education and some quasi- adults, this may be the ecological intervention social engineering projects that help to combat point. some of our more destructive values. With this emphasis on human ecology, it Families also need to make their way in 1 WAY TO GROW

16 is clear that a plan to serve families will include a be classified early intervention, treatment, and multi-tiered approach to defining the desired rehabilitation:" outcomes and then determining at whichlevel(s) the-liltervention will be most effective. 33 The The second fallacy is the belief that intervention plan, might target all or a combination prevention is impossible without knowledge of of the following.,affecting individual behavior specific causes. In actuality, there is evidence to change; affecting interpersonal inteoction support the strategy of providing educational change; providing resources or creating suport services that: (a) promote stress-resistant systems; and advocating for social change. capabilities; and (b) help people by hrreaisjri7 supportive services when they need them.

Prevention vs. Treatment The idea that prevention lacks a "technology" is fallacy number three. Actually, there are at least four preventive methods that Universally offered preventive services have a history of success, particularly when are the baseline in a comprehensive array of applied in combination. They are: education, programs for families. Prevention sounds good. promotion of competency, community and It is hard to argue with the concept. And yet it systems modificatim and support for natural continues to take a back seat to remedial services. caregiving systems." Part of the reason is a series of fallacies that prevail when considering preventive services. Another myth identified by Albee and Gulotta relates to the belief that evidence is The first fallacy is the common belief that lacking on the effectiveness of prevention; all services to young children and families are therefore, it shouldn't be tried. Medicine, preventive. The truth is, only efforts that are however, has successfully relied on correlational aimed toward groups of unaffected people, who data, and researchers have established show no signs of the problem, are preventive. relationships between stress and both physical Other services that look at "risk" groups are disease and mental ilness. Relationships have secondary prevention; those that remediate can been discovered between mental disorders and the mitigating and gotective benefits of providing support.piu "It is to accomplish ina The last fallacy deals with the belief that prevention is too expensive and that it takes systematic approach to money away from needed treatment. However, it is commonly accepted bat treatment programs strengthening the family aren't always successful. And at least in some cases, prevention has been estimated to save what has already been many times the cost in later remedial efforts. This is particularly true in benefits of quality accomplished in the medical early chiNhood education to low income and dental field (prevention Children and in low birth weight prevention.43

of many diseases) and other Even though the argument for prevention often begins with a discussion of the cost benefit community services, such as ratio, there are other considerations. These preventive sanitation." concern the concept of family stability and the high cost to overall cultural well-being when preventable deficiencies continue to develop. 10 Most other developed nations, particularly in the WAY TO GROW

17 West, have adopted a model of family support restoration strategies. Ideally, it is easier and based on a mode of prevention. They use readily cheaper to prevent problems from happening. available strates that have reduced their infant But problems are not prevented overnight, and mortality rates. there is still the question of what to provide in situations where the problem already exists- - Prevention consists primarily of where prevention is too late. The argument can improving the community resources that can be made that it is best to allocate resources to all strengths the functioning of all families and points along the continuum, with some children. 4° Areas that are often cited as maternal prevention services being available universally. and child health problems to be addressed by preventive services are: adolescent and other This continuum approach, with some unwanted pregnancies; low birth weight babies; universal services, is countered by those who birth defects; mjuries; dental caries; believe that all resources should go toward developmental emotional and learning problems; helping those most in needthose whose and family dylfpnction that leads to situations are on the special needs or critical end maltreatment.41 of the continuum. However, there are drawbacks to this targeted approach. When a The causes (or correlates) of the above particular population is singled out as possessing problems, which are found in all segments of some deficiency to eradicate, they are labeled to society, are multiple and interwoven. Poverty the rest of the population as different or lacking. does, however, correlate most highly. Isolation Labeling can undermine confidence, create and alienation from sources of support is a anxiety or create dependency, becse to solve recurring theme. Other sift ssors might include the problem is to lose the service.3.3 emotional problems or parental mental illness; racial or other discrimination; chronic phygcal Another diawback to targeting is that illness; or recent loss by death or divorce.4° often the individual targeted is perceived as Lack of information about childbirth and causing the problem. Thus, there is no impetus childrearing can also contribute to problems.4Y to see that problem as part pf an ecological system that has fostered it The task, then, is to "focus on whole communities and the relationship betweeg Targeting also assumes a sophistication families and their current enviromnents."Ju It is and accuracy in choosing a deserving population. to work for change in community practices that This is not necessarily the case. When predicting add to problems. It is to educate and support. It at risk children from peicipatal problems, is to enhance naturally occurring support Sameroff andChandler'J found that although systems. It is to accomplish in a systematic retrospective studies give a clear impression that approach to strengthening the family what has risk is predictive, prospective studies of the same already been accomplished in the medical and variables yielded a very large population of dental field (prevention of many diseases) and children who displayed pennatal problems, but other corn nity services, such as preventive developed normally. As Chamberlin has noted, sanitation. either one begins with a very large group of at- risk population, most of whom may not retain those characteristics in the long run, or one narrows the characteristics to eliminate over- identification, and serves a very small percentage Universal vs. Targeted of the total group who develop problems. He has observed that "the longer one follows a Services group of given children, the more likely they are to develop characteristics similar to the A service continuum, according to social/c I 1 milieu in which they are ming Brown,'- begins with prevention, moves to reared."° early intervention, problem solving and crisis intervention, and ends with rehabilitation and 19 WAY TO GROW

18 There seems to be a lack of clear-cut Child Development, a Chicago based program criteria for determining eligibility for an at-risk which offers comprehensive services to families population of childregAnAfamilies. Poverty still in order to foster positive health, social, and plays the largest role?' J° Poor educational outcomes for their children, planners socialienvirommtai conditions tend to amplify created a collaborative effort between several other problems. Y So, rather than search for just private and public agencies that could offer the right criteria, that in combination with low expertise and resources to the project. Local income and social deprivation produce.an at-risk support networks were identified, as were locally population, it is suggested instead to offer the offered services. All have been pressed into a community services necessary tpprevent some collaborative effort to sten!,en existing services problems and remediate others.w and expand where needed.'~'

In St. Paul, the Wilder Foundation has built a collaborative model to fill a "critical service gap" working with high risk young Collaboration families to prevent child abuse. The foundation Collaboration is the "buzz word" of the late 1980's. Alliances are being forged to create voluntary, yet binding collaborations to circumvent many of the roadblocks in established "What is called for is a more agencies and bureaucracies. The goal is to devise service delivery systems that make more sense responsive collaboration of for families. Most services today, at all levels of government, have individual eligibility criteria the key players in and delivery systems. Institutionalization brings with it "bewilderment, powerlessness and services to families..." alienation" that can overwhelm parents,seelcing help, particularly,low income parents. °I And yet, as Edelman w. has recently pointed out, there are few social problems that can be tackled by began by convening interagency project planning one agency or one program that will yield meetings to design a program that utilized the comprehensive results. In designing a new skills and resources of the participating agencies. approach to services, then, it makes sense to In this case key players, in addition to Wilder, avoid creating another bureaucracy that restricts are Ramsey County Public Health, St. Paul and entangles. What is called for is a more Schools Early Childhood Family F ucation, and responsive collaboration of the key players in Ramsey County Human Services. services to families, and an opportunity to enfold more minor actors as well. Agency collaboration during planning and implementation stages should insure streamlined This approach has been the focus of service deliveries and offer opportunities for several new initiatives in support programs for creative problem solving, while maintaining families. In designing the Interdepartmental agency integrity and mandated procedures. Coordinating Committee for Preschool Brown refers tgghis approach as "linkage Handicapped Children, the state of Maine pulled management."°° in three departments (Human Services, Mental Health & Retardation, and Educational & Cultural Services) to form a multidisciplinary steering committee to oversee their new initiative.°5 Community-Based Services

In designing the Center for Successful The concept of neighborhood-based 20services is not new. In the early 1920's and WAY TO GROW

19 1960's, especially, there was support for neighborivod organization and neighborhood III Arena for sociability: workers. 01 Recently there has been a rekindling Residents develop a network of friends of support, and several innovative program and acquaintances. models for community-based services have been Arena for interpersonal influence: developed. The assumption is that children and Residents share opinions, offer and families can best be helped by strengthening the receive advice and adhere to community primary and secopdary support systems within norms. their community.0° III Source of mutual aid: Residents offer emergency help and The antithesis of a community-based material resources (borrowed tools, model is one where clients come to services shared labor, babysitting exchanges). which are centrally located. The problem with Organizational base: this approach, as identified by Brown, is that Residents join together for PTA, "when client contacts are limited to set periods of neighborhood associations, Scouting, time and office interviews, professional practice etc. frequently excludes understanding and utilization Reference group: of the social environment, or the launching of Residents feel a sense of shared identity preventive or correctiyk interventions at the and belonging. neighborhood level." °Y Centralized services are Arena for status and recognition: usually bureaucratic, and often designed for ease Residents perform valued roles within the of delivery from the provider's point of view. community and share news of achievements. In order to be more client-centered, p:oviders of services need to take into account Most neighborhoods do not perform all certain elements of a client's neighborhood in six functions. However, "the variety and order to understand needs. These elements are: intensity with which these functions are carried socioeconomic characteristics, race/ethnicity, out serve to differentiate life within cultural patterns, types and density of dwellings, neighborhoods and the extent to which a history, other unique features, and whether it is particular neighborh '§ nourishing and viewAl as a desirable or undesirable place to sustaining for families". 3 live. iu The development of a community-based service model must begin with a thorough What about the community that is not assessment of these community elements and of "nourishing and sustaining," for families? the current service offerings (who is doing what Garbarino and associates have characterized for whom). "high risk neighborhoods" as places where neighbors don't help each other, there is a high A continuum of services can then be level of suspicion; and the community norms and developed, "ranging from supportive assistance behaviors inerease,family weaknesses, rather available to any family coping with crises or with than strengths. These factors lead to social problems in daily living, to protection of children impoverishment, which canzorrelate with high at risk and rehabilitation of seriously disordered rates of child maltreatment." families...The dual aims of service provision are to enhance the quality offamily and There is no doubt that low income neighborhood life and to safeguardchildren."71 neighborhoods have a tendency to be impoverished.. However, Garbarino et al76 A service model must also take into have developed a model that looks at high risk account the functions of a neighborhood, as set neighborhoods in light of degree of forth by Warren and Warren 14 and make impoverishment. They have found that, within decisions as to which functions are strengths of similar low income areas, there can be large community life and which need to be enhanced or differences in social richness and support factors. The impoverished neighborhoods have even developed. These functions are: 21 WAY TO GROW

higher rates of child maltreatment than would prenatal care rates between racial groups are normally be predicted, given the economic widening. Women who are at greatest risk of conditions. bearing low birth weight infants are often least likely to receive adequate, needed ce. This is What does all this mean for program especially true of teens and blacks. planning? It means that in neighborhoods that are Birth weights and infant survival rates are socially impoverished, and where parents much higher in Western Europe. Favorable do not receive the nurturance, feedback, pregnancy outcomes are achieved in both rural and support they perxl, rialdren are at risk for maltreatment." It means that attempts to provide services to those, children and families must begin with efforts to understand the social "The incidence of low environment and how it influences the success or failure of services. birth weight (less than 5.5 It means a thorough assessment of involvement of residents in community pounds) babies is a serious betterment projects. public health problem It means usmg professional resources to help identify indigenous community in this country." leaders and natural helpers and give them support to enhance their roles.'° It means designing a service delivery system that will work with the environmental forces in operation rather and urban areas. Even though the U.S. has a than against them. higher percentage of its gross national product going to health care than at least ten European countries, its statistics are worse. This holds true even when the statistics are disaggregated by race Prenatal Outreach Services and compared for white populations only. Rates of teen pregnancy, teen abortion, and teen childbearing are much higher in the U.S. than in The incidence of low birth weight (less most western European countries. Teen than 5.5 pounds) babies is a serious public health pregnancy declined rapidly in the 1970's in problem in this country. Low birth weight western Europe, even as fmancial benefits for contributes directly to the infant morWity rate, childbearing were expanding. Miller found that which is lower in 16 other counties. 'Y Low "Without in any way minimizing the urgency for birth weight babies are 40 times more likely to die within the first 28 days of life. They are 20 reducing poverty rates, especially in households times more likely to die within the first year. with children, a compelling case can be made that selective and direct approaches for improving Low birth weight children who survive infancy pregnancy outcomes are both feasible and. are at three times greater risk for incurring desirable, even within the press income lifelong disabilities such as cerebral palsy, mental structure of the United States."6-1 retardation, hearing gpid vision impairment, and learning disabilities.°u Women fail to seek and/or receive Quality prenatal care is necessary to adequate prenatal care for many reasons. The bamers to care can be classified into four major preventlpw birth weight and to ensure healthy babies.°1 Unfortunately, not all women receive categories: financial; health policy and health prenatal care. And of those that do, many don't care system deficits; service and program receive it soon enough. The disparities in disincentives; and individual and group health 22 care attitudes. A plan to increase the utilization of WAY TO GROW

21 care must aoldAress all four categories of barriers commitment from agencies and programs. to tha. care.°" Neighborhood locations or transportation to and from central locations is important. Health care Financial barriers are real. Not every providers must become increasingly sensitive to pregnant woman has adequate insurance cultural differences and to people's fear of coverage. Many fall through the cracks because medical p ures. Prompt, courteous service they are working poor. It is adequately is necessary. documented that if financial bamers are remqypi, it is possible to reach the poor and near-poor. °J Once the major barriers are reduced or eliminated, then comprehensive, coordinated Problems within health care systems ate outreach strategies must be employed to recruit varied. As a group, obstetricians are the least women for prenatal care. Marketing strategies likely amom primary care physicians to accept might include a massive public education Medicaid. Programs and benefits are rarely campaign Inpitlizing culturally sensitive materials coordinated to ensure easy access and optima' and models?' Telephone "healthlines" provide benefits to clients. Different eligibility information in a non-threatening way and can requirements, travel to different sites for even be used to set up initial appointments. services, and complicated documentation Outreach workers can be effeqtive in reducing requirements all serve to discourage the users.87 personal fear and alienation?" They can also provide the emotional and social support Service and program barriers range from necessary to compensate for a lack of such accessibility of services to provider practices and support in the motiwg'4,14fe and enable mothers to attitudes. The following al. sore to deter continue their care. participation in prenatal care:" There are many good examples of III Low Medicaid enrollment rates; successful prenatal outreach programs in the Lack of transportation; United States. The Obstetrical Access Pilot Location of services; Project at selected sites in was Lack of child care; successful in reducing the percentage of low birth IIIService hours; weight infants by 33 percent for program IIIService delays; and participants at a cost of only five percent over the Provider practices and attitudes. average cost of care provided by Medi-Cal. That suggests a great reduction in long-term public The individual's attitudes or her identity expenditures to care for low birth weight infants group's orientation toward health care can also in nowtal intensive care other hospital prevent the seeking and utilization of prenatal costs.?/ Locally, pretenn birth prevention care. Teenagers feel shame and fear. Some programs offered by Group Health Inc. and people may lack knowledge of the health care Hennepin County Medical Center have shown system gr may have conflicting cultural significant reductions in rates of premature beliefs. Low income women may not realize births. Both the Maternity and Infant Outreach the importance of prenatal care and may have Project (Hartford, Connecticut) and Central Harlem Outreach Project (New York) have been dissatislI /with earlier health care experiences. demonstrated success in reaching pregnant women and seeing them through pregnancy. If utilization of prenatal care is to be Two programs particularly successful in improved, barriers must be attacked from all providing social support to pregnant women are sides. It is obvious that financial barriers are the Prenatal/Early Infant Program (Elmira, New overriding when they exist. But even in cases York) and the Better Babies Project where the financial barriers are removed, others (Washington, D.C.).98 The Infrint Health remain. These must be addressed first. The Promotion Coalition of has demonstrated delivery of services in a more comprehensive, successful mass media and other marketing less fragmented way will require cooperation and 23 WAY TO GROW

22 strategies through Community Baby Showers consequences. Maltreating parents often find that combine both case finding and prenatal infancy and toddlerhood a trying time, andseem education, and through a telephone referral unable to find a balance between adequate service, 96l-BABY. YY nurturing and allowing sufficient autonomy, both of which are crucial pgrental tasks for optimal One last reason to involve women early in child development.1U5 prenatal ose.--is-ro create access to the family for later intervention. Project STEEP, designed after The National Center for Clinical Infant a ten-year project at the Pro ,in.their publicationInfants Can't studied low income mothers and their first borns, Wait, proposes two major initiatives for enrolls women in their last trimester of pregnancy. It attempts to teach basic development, help mothers be better "perspective takers" when interacting with their infant', and to be supportive and net mothers' emotional "The inadequate patchwork of needs. "We believe there are strong indicators even before the baby's birth that a mother is services that exists to unlikely to provide the sensitive responsive care necessary for ttinfants' optimal promote healthy development, development.", in the critical first months and years of life is in sharp The First Two Years contrast to our broad-based system of public education Infants Can't Wait.As the title of a publication of the National Center for Clinical for older children, which is Infant Programs suggests, infancy is a crucial time, physically and emotionally. The human seen as an opportunity capacities for loving and learning are rooted in experiences of the first two years. guaranteed to every Impoverishment during this period shovis up later as ennioilancl,developmental American child." disorders. Jul IU3 And yet 25 percent of all babies in the U.S. are born into poverty.,, Twenty percent are born to single mothers. ivm services to parents and their infants and toddlers. We do know what babies need for The first is to establish "a basic floor of optimal development. We know what danger integrated services" that includes preventive signs to look for. And we know,phat parents health care, provision for economic well-being, need for their own fulfillment. R" And we knpAv, family support, and quality dailycare that also that the earlier ,t,intervention the better.ilm enhances and facilitates development. Secondly, Ramey and Bryantiw choose age two as the they recommend an expansion of specialized time marker distinguishing prevention from risk. services for parents and their infants and toddlers They argue that the prevention of mild mental with special health and developmental problems. retardation depends on early identification of high The tasks of providing for their infants' needs risk factors and the intensity of treatment. fallsehiefly to parents, but in contemporary Researchers at the University of Minnesota have America the support once afforded by stable found during a ten year study of 267 high risk neighborhoods or closely knit extended families families of first born children, that the earlier that may not be available. Instead, stressed parents maltreatment occurs, the more severe the must often negotiate a system of fragmented 24 WAY TO GROW

23 services to find help, and too often .services they Current research on social networks and need are not within reach. While there are, to be social support is encouraging. Evidence is sure, examples of excellent general and highly accumulating that suggests that adequate social specialized services that address the needs of support can help to prevent and/or alleviate a infants, they. are too few in number and are not variety of social and developmental ills, including well coordinated. The inadequate patchwork of low birth weight, life stress, and negative parent- services that exists to promote healthy child interactions. It can be argued that a family development in the critical first months and "years support component in an early childhood ..of life is in sharp contrast to our broad-based program both attracts parents to the service argljs system of public education for older children, important to the effectiveness of that service. A which-is seen as an oppounity guaranteed to every American child Any proposed plan of services must, then, integrate and provide-for support services For infants and toddlers to grow which enhance the family's ability and desire to optimally, they need sensitive, responsive participate. The goal of providing support is to caregiving from their parents. Some parents give families what they need to function need additional help and support in order to competently and to meet the developmental needs provide what their children need. Programs that of their children. This can be done by creating are designed to offer comprehensive, integrated "formal support systems that generate and services need to consider the human element in strengthen infomial support systems, th4t,ip turn those services. Change does not occur simply by reduce the need for the formal system." IL° learning new information or being taught new skills. "Change can only oh :cur through There are several questions to consider integration of the experiences of child-rearing and when designing a program of support to families: relations with others, such as a concerned worker with adequate timeitp,provide care to both the What constitutes sup rt? mother and child".' Who is best equi is-. to provide support? How can we posse ly afford to provide support to every family that needs and wants it?

Family Support It seems evident that, for several reasons, professionals alone cannot do the whole job. To paraphrase, "No family is an island." They are too costly, and relationships with Parents who attempt childrearing in isolation, professionals are not ongoing, enduring, or even in the middle of a large urban area, are cut based on mutual give-ana-take. Unless they are off from necessary nurturance and feedback from careful, professionals may unwittingly create others. Their stess.jaels increase. They- live dependence all their services and thwart self-help impoverished lives. 14 initiatives. fiIt would appear, then, that the For many, support is an integral part of everyday existence, with ties to one or more social networks that 2rovide information, emotional reassurance, physical or material "It seems evident that, assistance, and a sensepf,self as a person worthy of the regard of others.For"3 others, for several reasons, community life does not offer the opportunities professionals alone cannot for enriching support networks. There are not enough available people who are "free from do the whole job." drain" to create a give-and-take. Often, for those families whose life circumstances pAtlhem in most need, the support is notthere.' 25 WAY TO GROW

24 professional's role in a community-based, Bureaucratic restrictions; comprehensive program of services with Economic self-interest of professionals; emphasis on support will need to be redefined. The narrow, technical focus of the professional role; What seems to be called for in designing The hierarchical structure of professional- services is the creation of a franiework that paraprofessional-volunteer roles; and integrates the benefits and services from the Institutional mandates that define Community's naturally occurring informal services. helping systems with professional services. The idea is to help families plug into social support These barriers point to the need for networks and to _support already existing commitment from agency heads and policy relations'uips in order to enhance, complement, makers to the importance of support in the lives and offer alternativesito the conventional human of families. Services need to be designed in service approaches. In order to achieve, this ways that support bmilies rather than reflecting integration of professional,aild naturally "what professionals and instituJQns know how occurring support, more resources need to'be to do, or have funding to do".14° directeditoxiard providing primary social support.' "

How doe:; this integration take place? Professionals work with existing social support Home Visits by networks to achieve a rich environment for families. They recognize the complementarity of Paraprofessionals personal and socja"" kresources and seek to strengthen both. They recognize the limits of The paraprofessional home visitor idea is professionalism and deSir., their rolesto both one that is resurfacing in family support facilitate the development of informal networks literature. Its history is rooted in the late 19th and use their expertise to treat special problems century, when upper class women volunteered to and intervene in crises. If professionals are be "friendly visitors" to poor families to offer committed to working within the existing social .moral guidance. From there, as the field of fabric and to performing in a consultative role, social work was professionalized, social workers they can continue to serve fniimportant function and public health nurses worked out of settlement in the delivery of services."' houses in the early 1900's to try to integrate Some new helping roles of professionals can be: profv,ssional services into the community. In the late "1960's and early 1970's, a new twistwas Consultant to informal family support added: finding talented, skilled,non- systems and,fiatural helping professional membexpf a targeted communityto networks'44; work with families. ", In the 1980's, research Treatment agent, providing face-to-face, is accumulating that once again points to the therapeutic intervention; efficacy and value of training paraprofessionals III Teacher-counselor, providing advice, to visit families at home to help parents provide information, and skill development; an optimal environment for their children's Broker of services/resourets, providing development. the services of a "case manager' ; C Family advocate, acting a.sintennediary The concept of home visits to families of with agencies and services" .3; and newborns to be discussed here is notone of a III Leader of a team of paraprofessional treatment or educational plan to be delivered on home visitors and community workteg, the family's own turf. Rather, it isa concept that providing supervision and training.11i4 looks at the home visit as an opportunityto bridge the gap between profe§si"° gnal service Whittaker125 outlines thepotential agencies and the community. It is an barriers to this integrative approach. Theyare: opportunity to accomplish an initial, mostly 26 WAY TO GROW

25 informal, assessment of what kinds of support need to be tailored to each particular family. The and information families may need in order to be list below identifies the realm of possibilities: effective parents. And finally, it is a mechanism to offer support and to encourage parents to To "befriend" the parem serve as an utilize the services available to them. When ally in times of stress.'" home visits are available at an initial level to all To educate in basic skills sucjvs: health families, the stigma usually attached to being caret"; accident prevcrixtion13Y; and singled out for service is removed, and each new feeding and nutrition.I4U parent cginkw that there is help available if 111 To help parents link up with- approgiate needed. ortventive and treatment services."'" The utilization of paraprofessionals in the '142 context described above makes good sense. A To serve as a model for positive person, preferably a mother from the community interpersonal relation-ship§pcularly who can "befriend" the family at a time of parent-child interactions.'43 vulnerability (as transition to parenthood is), is in To conduct informal accfkg possible risk factors. 148 To help parents understand their role in promoting socially and intellectually competent behaviors in their children, AQd "When home visits are to perform this role.I4Y IvAIliniques available at an initial level To help parents understand the importance of utirg their own natural to all families, the stigma helping systems.' usually attached to being The task of the home visitor then, is to singled out for service is shift back and forth among the above objectives based on her assessment of priorities and needs. removed, and each new For many families, a few visits will be enough. For others, an ongoing plan can be developed parent can know that that includes continued home visits as well as there is help available other professional support services. There are many examples of successful if needed." home visit programs. A Montreal program showed that home visits begun prenatally contributed to reduced accident rates; higher assessments on home environment and maternal a unique mtiomj offer support and behavior scales; lower prevalence of interaction nurturance." 134 The community resident or feeding problepand a higher prevalence of can provoke less suspicion, exhibit acultural involved fathers.'" In a Cambridge, familiarity and respect, draw from personal Massachusetts program (Family Support experience, and morcglosely resemble a natural Project), families were randomly assigned to helpingrelationship.'33 Problems are more either a paraprofessional home visitor with likely to come, to the attention of a home visitor in occasional parent meetings or to a professionally an atmosphere of trust. And there is sufficient staffed group process with professional home evidence to suggest that trained paraprofessionals visitors. There were no significant differences are capable of deterThip which children and between the outcomes of the two services; if families are at risk. "4 anything, the paraprofessionals appeal to be rated more favorably by participants. The goals to be accomplished by the paraprofessional home visitor are multiple, and A similar finding came from the comparison of a 27 WAY TO GROW

26 traditional home visit program with an agency problems with a deficit approach are: (1) being based rehabilitation program which included labeled "sick" or dysfunctional is detrimental to several components. Both models attempted to one's sense of competence; (2) needing enhance the mother-child relationship with professional help may create dependency166; mentally ill mothers. Both interventions and (3) many fares may be left functioning exhibited "marked improvements" in qv/her and only marginally. child, with no measurable differences. "3 A study conducted in Aberdeen, Scotland A non-deficit approach, on the other concluded that a home visit assessment can serve hand, works to identify strengths and increase as an accurate predictor of home and parent competence. It focuses on identifying inner factors that lead to sulvAuent child health and/or resources as well as environmental resources. maltreatment factors. "° A Denver hospital Assessment and intervention are directed eq y offered home visits by paraprofessionals as a to the person or family and to the situation.' routine part of pediatric health care. Visits were There is a presumption of potential and ability to judged successful in identifying families who change. It employs a denwatic approach, with were at risk for malseptment and who needed professionals as partners.'" The focus is on long-term services. ski evelopment, motivation, and environmental fit. The effectiveness of paraprofessional home visitors is dependent on effective One of the major benefits of using a non- recnfilartppS, Rpm and supervision of deficit approach with families is that the emphasis visitors. 1"° luu It is also important to on identifying strengths is consistent with understand the need for clear role definition; for promoting a posiiiye self concept for all family recognizing the tensions confronting the home members. Satir" I identifies four potential visitor in negotiating between,9,mmunity loyalty problem areas in families: self worth, and professional expectations 1°'; and to p vide communication, rules, and the nature of the an effective professional back-up system.' family's link to society; with self worth being primary, because of its pervasiveness. If one member's mem suffers, the family suffers. Garbarinol /4 defines positive self regard as one of the basic tools of healthy development. It is A Focus on Family Strengths very important then, to build a method of working with families on a foundation of esteem- A program model consists of at least two building. parts: what the services will be; and, how they will be delivered. The "how" describes approach. The approach recommended here is to focus on family strengths and enhance development in specific ways. The antithesis to Enhance the Parent-Child this approach is to focus on deficits or weaknesses. A problem is identified, a diagnosis Relationship is made, and a treatment prescribed. The target is usually an individual; itmore difficult to The early infant-caregiver attachment prescribe for a system.'w Some assumptions relationship provides a "prototype" of later are implicit in this approach: there is a minimal relationships. Once established or not acceptable level of functioning which is the goal established, this pattern is difficult to change and for this person or family; and once the seems bound to repeat itself in later,Wationships, dysfunction is remediglpr minimized, services particularly if the cycle is negative.' /-3 If are no longer needed 1°4 Another assumption is attachment is thwarted by an abusing, neglectful, that experts (professional social workers, health or psychologically unavailable mother, or by one care providers, teachers) are needecl,tp help "fix" who is chronically depms§ef17ffie child's the situation or remedy the deficit. 1°J The development is at risk. low 2. 3 WAY TO GROW

27 self esteem, being an abuse victim, and When the task is approached from an academic experiencing multiple stressors in relative or training framework, it is difficult to pinpoint isolation are all factors that seem to thwart what will produce change. Change agents are formation of a strong maternal-child bond. not methods or curricula; they are people. In a program they are teachers, social workers, The results of an insecure attachment or paraprofessionals, nurses, or counselors. The emotionally unresponsive parent-child relationships they build with parents "provide the relationship appear to be devastating, as much or scaffolds tr. building or re-building parenting more so than, Aphsically abusive strength." 10 relationship. " Impairment in language and cognitive skills, considerable negative affect, In essence, in families where the parent- child relationship is likely to be or already is in trouble, the tasks are: (1) to begin by parenting (re-parenting) the parent; (2) to develop a partnership based on mutual respect and "The results of an insecure collaboration; and (3) to provide a model relationship where the staff person is accepting, attachment or emotionally accessible, reliable, patient, persistent, consistent.d communicates a pervasive sense unresponsive parent-child of caring. relationship appear to be devastating, as much or more so than aphysically abusive relationship."

low self esteem, poor impulse control, and non- compliance are all demonstt ated in children whose mothers are psychologically unavailable or abusive. The implications for intervention when the parent-child (mother-child in particular) relationship is dysfunctional are many. Working to identify areas of competent mothering is necessary. Building a sense of confidence by providing information about children's needs is important. Working to enhance the mother's self esteem and to meet the mother's owns 46 tional needs-by providing support is crucial.' '79

The field of parent education and support is not a highly developed discipline. Research on efforts to work with and/or "change" parents yields mixed results. There is currently scant evidence of long-term change of parental n 29 behaviors due to educational intervention. °V Chapter 4 WAY TO GROW The Plan

Way To Grow Program Components

Component 1: Mission Statement Community Linkages In order to increase the accessibility and utilization of existing services for Minneapolis A proposed plan to promote school families and children, Way to Grow would readiness of Minneapolis children by build a referral network Families of children prebirth through age five would be able to call the coordinating a continuum of central number at the Way to Grow office and comprehensive, community-based get information on resources and services available to them in the Minneapolis area. services that support and assist all parents Service providers would be able to call the central in meeting the developmental needs of number and get specific information on other agencies, such as services offered, cost, their children from conception through openings, waiting lists, etc. This information age five. would be updated at least quarterly. Simple forms and procedures would be developed for referral and follow-up of families by service providers throughout the Minneapolis area. Way to Grow would work closely with the Goals Minneapolis and Minnesota Departments of Health in examining the need for and feasibility Encourage families to make better use of of an infant and child tracking system. existing community services. The process of collecting and updating Help families to build a network of information for this referral system would also friends, relatives, and community people identify needed services for Minneapolis to support them in raising children. families. Way to Grow would develop plans to expand existing resources to meet these Expand very early identification of identified needs. Innovative partnerships among physiological and environmental factors service agencies would supply some needed which can be deterrents to school services. In areas where the need for new readiness. funding is clearly indicated, Way to Grow would actively seek those resources. Identify needed services for families and children and find ways to support them.

Raise public awareness about the Component 2: importance of healthy child development from conception on and about practices Direct Service Continuum that will promote healthy development. Way to Grow proposes a continuum of Raise the quality of community services direct services for families of young children by providing programs with information, from conception through age five. This technical assistance, and incentives for continuum would be available to all community coordination. residents, with service level based on identified need. See Figure 4.1. 30 Figure 4.1 WAY TO GROW

Minneapolis Way to Grow Direct Service Continuum

29

MODERATE RISK FAMILIES

PRENATAL PERIOD (EXPECTANT PARENTS):

strategic outreach efforts transportation to community services therapeutic services public education as needed prenatal health care home visits by pulal-- health nurse nutrition information/support and/or paraprofessional childbirth education family planning information information about other Minneapolis Way to Grow components

FIRST THREE MONTHS (FAMILIES OF NEWBORNS):

outreach by hospital staff and home screening and assessment therapeutic services birth networks at delivery additional home visits by public health case management family planning information nurse and/or paraprofessional up to 4 home visits by community- based paraprofessional or public health nurse within first year parent education/support child care resource and referral information about other Minneapolis Way to Grow components

THREE MONTHS TO KINDERGARTEN ENROLLMENT (FAMILY SUPPORT AND EDUCATION):

ongoing outreach further screening/assessment early childhood special education parent education/support for special needs day care therapeutic preschool/child care mothers and fathers in respite child care/crisis nurseries individual family service plans neighborhobd and workplace drop-in centers for parents and therapeutic parent and/or child preventive health care children services family planning information transportation to community services case management immunizations as needed screening specialized parent and/or child nutrition information/support services child care resource and referral home visits by public health nurse, affordable quality child care social worker, teacher, and/or information about other Minneapolis paraprofessional home visitor Way to Grow components developmental preschool/child care assistance with job training/placement skills forparents WAY TO GROW

30 Most services on this continuum are of what kinds of support and information already offered by public and private providers in families may need. Finally, they are a Minneapolis. (See Appendix D for a partial list) mechanism to offer support and encourage Many need to be expanded and/or better parents to utilize services available to them in coordinated to make this continuum a reality for Minneapolis. all Minneapolis families. Way to Grow would provide this coordinating function, as well as It is important to offer and promote these identify and address needs for expansion or home visits to all families of newborns, both to development of new services. accomplish the ends noted above and to reduce or remove any stigma currently attached to the use One area of need has already been clearly of outside support and assistance following the identified through the interviews, literature birth of a child. Nurses from both Hennepin review, and other planning activities for Way to County Medical Center and the Metropolitan Grow. This is the need of all families for Visiting Nurse Association acknowledge that support and information in raising children. An they are not always able to gain access to the excellent entry point for these services is the birth homes of high risk families. By employing of a child. Currently, the Metropolitan Visiting trained community residents as home visitors and Nurse Association-(MVNA), which operates out promoting the service to all families, Way to of the Minneapolis Health Department, employs Grow hopes to significantly expand the number 25 public health nurses and five paraprofessional of families receiving home visits after the birth of Parenting Aides. In 1986, MVNA visited 2,766 a child. families in Hennepin County, of which 760 were identified as high rislci, Most of this total were To accomplish this, Way to Grow families of newborns.' would issue a request for proposals for 11 small planning grants citywide to nonprofit agencies. Home health care nurses from several The purpose of the planning grants would be to hospitals and a few HMO's, such as Group provide incentives for agencies to collaborate in Health Inc., make single home visits for seeking Way to Grow home visit funds for maternity followup on request. They then will their communities. The 11 communities will be often refer families in need of further services to defined by boundaries used by the Minneapolis MVNA. Planning Department, since much demographic information is already collected using these In 1986, 6,564 babies were born to defined areas. (See Figure 4.3.) Operating Minneapolis residents. Of these, 36 percent were grants would be provided to collaboratives in born to unmarried mothers. Sixty-eight percent each community that offered a cooperative, well- were white; 31% were non-white. Twenty-two organized, feasible, and sensitive approach to percent of the mothers had less than 12 years of delivering home visit services as evidenced in the education; educational levels were unknown for proposals resulting from their planning grants. 19 percent of the mothers. Only 70 percent of The home visit expansion would be phased in the mothers began prenatal care within their first gradually, beginning in about four communities three months of pregnancy. The remainder the first year. began prenatal care later or were uncertain in which trimester they first sought care. Some A community grantee for operating funds received no prenatal care at all.(See Figure would be required to assemble a supervisory 4.2.) team for the paraprofessional home visitors who will work out of its collaborative. This team As discussed in Chapter 3, the home would include individuals such as a pubic health visits to families of newborns proposed for the nurse, a social worker, and a Minneapolis Public first major Way to Grow initiative are an Schools Early Childhood Family Education opportunity to bridge the gap between teacher. A community organizer/outreach worker professional service agencies and the community 2 would also be on the staff. The team would then They also provide an initial, informal assessment recruit and hire paraprofessional home visitors Figure 4.2 WAY TO GROW

Minneapolis Resident Live Births, 1986 By Community By Selected Characteristics Age Group: All Ages

MPLS CAM. N.E. N.N. CEN. UNV. C.I. PHL. POW. LNG. NOK. S.W. UNK. TOT. AREAAREA AREA AREAAREAAREAAREAAREA AREAAREAAREAAREA CHARACTERISTICS

TOTAL LIVE'BIRTH 6584 574 879 988 198 297 313 471 1120 510 660 758 16 LEGITIMACY YES 4202 423 498 370 89 224 237 185 578 385 552 675 8 107___ 84__ NO 2362 150 183 598 109 72 76 306 543_ 126_ _ _ UNKNOWN 0 0 0 0 0 -0 0 0 RACE WHITE 4426 490 637 350 85 189 266 120 591 435 574 681 7 BLACK 1236 40 8 475 70 48 30 112 321 22 55 46 7 AM. INDIAN 475 22 22 68 21 12 9 158 112 27 14 8 2 68 20 38 8 72 81 17 13 17 0 ASIAN/PACIS___ 357....._14 6 ...... _ _ _ 2 0 0 0 1 1 0 0 0 0 UNKNOWN 68 7 7 7 0 8 2 9 12 8 4 4 0 BIRTH WEIGHT 0-2000 GR. 185 12 13 50 7 9 8 11 31 11 15 10 2 2001-2500 GR. 336 31 29 70 18 11 16 22 SO 22 25 22 2 2501 + GR. 6021 526 833 844 189 278 288 430 1018 478 622 725 12 UNKNOWN 22 6 5 3 3 5 0 1 2 0 0 2 6' MOTHER EDUCATION <8 YEARS 116 3 2 32 3 1 2 36 31 3 1 2 0 8-11 YEARS 1041' 79 81 315 46 17 17 141 214 81 34 34 T 12 YEARS 1582 198 173 289 40 40 50 117 293 120 159 100 4 13+ YEARS 2513 195 225 198 67 191 164 77 323 241 343 483 5 UNKNOWN 1305 99 ids 138 40 '46 80- -...49 262 17 121 157--- 6' GESTATION 16 25 63 8 8 12 16 42 13 12 15 0 ."... <35 WEEKS .230 ... .__. . .._ 110 9 28 4 4 17 10 7 7 1 36 WEEKS 175 13 9 30 5 10 6 21 38 9 11 20 2 37+ WEEKS 4516 419 404 673 134 215 202 295 714 370 513 585 11 UNKNOWN 1533 115 227 178 48 61 82 al 310 106 119 151 /- PRENATAL CARE NONE 153 4 13 25 8 8 3 25 34 17 9 7 2 1ST TRIMESTER 3678 389 381 493 91 185 194 138 516 308 455 513 3 2ND TRIMESTER 1104 72 66 233 43 44 39 140 231 73 76 82 5 3RD TRIMESTER 300 12 14 74 18 10 7 53 73 17 9 12 0 I 555' 55 '268T44---55 5 i 55 i HI 'Wit it iot "144- I-- PRENATAL VISITS _153 .4 13 25 8 6 3 25 34 17 9 7 2 .,NONE .. ,...... _ .. ._ . __ _ _ .... _ _ 1- 2 1 0 28 25 3 0 3- 4 244 14 10 68 9 6 5 40 60 19 6 8 1 5- 6 324 17 28 72 14 11 9 52 73 20 13 14 0 7- 8 584 48 37 117 18 17 20 41---i/g 42----55- 56----5. 9-10 958 113 103 177 21 41 44 62 129 74 85 109 0 11-12 1269 134 118 159 34 68 59 51 192 102 162 189 1 13-14 898 75 81 102 29 53 58 34 124 73 128-- 140 1 15+ 634 67 64 75 15 33 42 21 98 56 78 86 1 UNKNOWN 1374 101 221 134 39 60 71 107 258 104 122 154 4 NOTE: SUMMATION OF INTERNAL VALUES MAY NOT EQUAL TOTALS DUE TO ROUNDING

SOURCE: Minnesota Department of Health Statistics, November 1987 33 Figure 4.3 WAY TO GROW

Minneapolis Communities and Neighborhoods

f Shingle Creek Lind Selma Hum., III Ind. Arta 32

Victery . Camden Columbia Waite Park CAMDEN Marshall NORTHEAST Terrace Cleveland Fe !well Mc WI.; Audubon Park J Holland ettineau Windom Park I Jordan I Hawtherne ._ Logan Northeast Park Sheridan Park NEARNORTH

St. Anthony MidCity Industrial Area WillardHay Beltra Near North West East ---1 Como MarcyHolmes UNIVERSITY Harr Ise's -----i ...... -1 University of BrynMawr MinnesotaProspect Park coring rare edarRiverside East River Road Lowry Hill West Bank

litenweed East Seward PHILLIPS Isles Lowry A HOUNISLES Hill CedarIslesDe East Longfellow Cooper POWDERHORN West ECCOCa rag Lynda!, PowderhornCorcoran Calhoun Park Central LONGFELLOW

Howe

Standish Bryant Bancroft /Sm....11 King Field East Linden Hills arm! Regina Northrup ric son Hiawatha

Field i Fuller i Fulls', Lynnhurst Ketwaydin i SOUTHWEST / Minnehana i Hale NOKOMIS ... I Page L ,____L_ p Wenonan Morris Park N Kenny Armatage Windom Diamond Lake

I. J

3 4 WAY TO GROW

33 from the community, with special efforts made to the baby to come. When appropriate, the home attract qualified persons who reflect the visitor might facilitate small groups of parents or demographic makeup of that community. expectant mothers at community sites. Parents Guidelines for the recruiting and hiring process would be encouraged to participate in the would be provided by the central Way to Grow Minneapolis Public Schools Early Childhood Board. Family Education program (See Appendix F) or other parent education programs in their Once home visitors are hired, 120-180 community as soon as they are comfortable doing hours of pre-service training, as well as ongoing so. in-service training, would be coordinated by the central Way to Grow staff. The community Home visitors would continue to act as Way to Grow team would provide daily resource persons to families (including contacts supervision and support for the home visitors, by telephone) as needed until the children enter with a specific supervisor identified for each ldndergaiten, or the family moves to a different home visitor. The team would also help community: In the latter case, families would be determine when a family should be referred for referred to the Way to Grow office in their new additional assessment or services, or when a community, and a new home visitor could family might benefit from direct visits from the resume contact with them. The original home public health nurse, social worker, or Early visitor would remain involved with the family Childhood Family Education teacher. through the transition period and until this contact is established. Home visitors would provide a variety of services to families in then community, with the bulk of their time devoted to home visits in the first year of an infant's life. Services would Component 3: include: (1) parent education; (2) enhancement of Public Education/Outreach informal support systems; (3) information about available community services; (4) suggestions as In order to reach and involve all to what further assessment or services the family Minneapolis families of children prebirth to may need; and (5) provision of some basic kindergarten enrollment, Way to Grow would advocacy functions for families who use a large implement comprehensive, ongoing outreach number of services. strategies citywide. Obstacles to participation of both families and service providers would be Intensive outreach would be conducted identified and addressed. The Way to Grow by the central Way to Grow office and the central office would also assist local agencies in community collaboratives through their developing outreach plans for their communities. community organizers/outreach workers. This ongoing, strategic outreach would begin through Public education strategies to promote the prenatal health care providers, hospital obstetrics healthy development of children and families staffs, and well-child health care providers would be employed through posters, newsletters, citywide. It would also reach out to other service brochures, billboards, public service providers, the general public, and directly to announcements, etc. An obvious first focus families of newborns, working in close would be the promotion of early and regular cooperation with the Minneapolis Health prenatal care, which could be offered in Department. cooperation with the March of Dimes Foundation. Home visitors would begin contact with most families on request after the birth of their Way to Grow would report annually to child. But for women identified to be at risk, the Minneapolis Youth Coordinating Board and they would offer home visits during pregnancy, other appropriate policymakers on its activities encouraging women to begin or continue regular and on family service needs identified through prenatal health care and realistically prepare for 3Vay to Grow. 3 WAY TO GROW

summative (outcome) evaluation. It is important Component 4: to begin with formative evaluation, because it is Education /Training futile to look at outcomes of a service delivery system without first determining how well the A primary function of Way to Grow's system is operating. Formative evaluation efforts training component would be 120 to 180 hours would include measurement of parent and service of pre-service and ongoing in-service training of provider satisfaction with Way to Grow paraprofessional home visitors hired through activities. community collaboratives. Current curricula and consultant trainers from a variety of disciplines Assuming this base of formative will be combined carefully and supplemented as evaluation, stunmative evaluation could include necessary with new training modules to be assessment of outcomes such as: delivered by Way to Grow staff and others. The goal will be to create a comprehensive use of community services by families; package of pre-service and in-service training availability of support systems for uniquely suited to the Way to Grow home visit families (involvement of fathers, other expansion. Training will include a blend of relatives, friends, service providers, etc).; theory and technique, offered through readings, birth weights of babies; visual aids, lecture, discussion, role playing, child accident rates; etc., to engage paraprofessionals with a variety rates of prenatal care obtained within first of learning styles. trimester, public awareness of early childhood Consultation and support for child care ir. des; homes and centers and other early childhood reported cases of child abuse; agencies will be provided by Way to Grow, rates of screening and assessment; and again utilizing training provided by existing kindergarten benchmark scores. agencies whenever possible. Evaluation and research efforts would be Finally, Way to Grow would promote shared. The evaluation would be designed by (when available) and develop (when needed) pre- central Way to Grow staff, with expert service and continuing education on early consultation. The University of Minnesota and childhood topics for professionals such as Wilder Research Center could potentially assist in pediatricians, obstetricians, family practitioners, research design. Implementation would be a nurses, social workers, child protection workers, joint effort of community collaborative staff, etc. The content would be focused on areas such central Way to Grow staff, and where as: an overview of Minneapolis Way to Grow, appropriate, independent evaluators. The normal child development, parent-child Minneapolis City Planning Department would attachment and interaction, developmental issues, continue to collect descriptive data from each of ethnic and cultural sensitivities, and traits of the 11 communities. healthy families. The outcomes listed above, as wellas factors such as parent-child attachment and interaction styles, nutritional practices, parental Component 5: knowledge and attitudes, coping skills, and home Research /Evaluation environments of Way to Grow home visit recipients would be measured and compared Research and evaluation of Way to where possible with measures of familiesnot Grow activities will be a critical part of Way to receiving home visits at the birth of their child. Grow administration. Evaluation efforts would Since the Way to Grow home visit expansion focus initially on establishing data collection is likely to be phased in gradually, controlgroup populations will be available within Minneapolis systems for both formative (process) and. 36 for a time and then could be drawn from nearby WAY TO GROW

35 communities.

Instruments such as: the H.O.M.E. scale by Caldwell and Bradley; the Nursing Child Assessment Screening Tool (NCAST) by Barnard; the Community Interaction Checklist by Wahler, the Family Coping Inventory by McCubbin et al.; the Family Support Scale by Dunst et al.; the Parental Attitude Checklist by Boyd and Stauber, the Parenting Stress Index by Abidin; the Strange Situation by Ainsworth and Wittig; and child screening instruments such as the Preschool Screening Inventory by Ireton would be possibilities for outcome assessment measures. Chapter 5 WAY TO GROW

The Implementation

36 Minnesota Chapter of the American Academy of Organizational Structure Pediatrics Minnesota Council of Health Maintenance We recommend that the Minneapolis Organizations Youth Coordinating Board assume primary Minnesota Council on Foundations responsibility for implementing Way to Grow. Parents in Community Action Inc. (Head Start) Community Linkages, Public United Way of Greater Minneapolis Board of Education/Outreach, Educationarairiing, and Directors Research/Evaluation (Components 1, 3, 4, and United Way Council of Agency Executives (5 5) would be implemented by Way to Grow representatives) staff, operating out of a central office. Services Urban Coalition of Minneapolis listed for Component 2, Direct Service Four Members-at-Large, all parents of young Continuum, would be implemented by public and children private providers citywide, with linkages and some support services provided by Way to Since the Management Board will be Grow staff. awarding grants for home visit services to community collaboratives which may involve Way to Grow staff would report organizations that are also members of the Way directly to a 30-member Way to Grow to Grow Board, bylaws and proposal review Management Board; which would be appointed procedures must be developed to address by the Minneapolis Youth Coordinating Board. potential conflicts of interest. To keep the Management Board to a workable size, it is necessary to limit the number of Estimated staffing needs for the central organizational entities represented on the. Board. Way to Grow office include the following: The Board would have the authority to create advisory task forces and ad hoc groups for specific program direction, allowing for the input 1 FTE Program Director: of additional organizations and agencies. Responsible for overall management of Way to We suggest staggered terms of two to Grow. Reports to and works closely with Way three years for representatives of the following: to Grow Management Board and Executive Director of Youth Coordinating Board. American College of Nurse Midwives Advocates for Way to Grow activities with American College of Obstetricians and policymakers and funders. Supervises central Gynecologists Way to Grow staff. Community Clink Consortium Greater Minneapolis Chamber of Commerce Greater Minneapolis Council of Churches 1 FTE Community Linkages Greater Minneapolis Day Care Association Coordinator: Hennepin County Community Services Department Responsible for establishing and updating central Hennepin County Medical Center information and referral network for families of Indian Health Board of Minneapolis Inc. chilOren prebirth through age five and service Minneapolis Children's Medical Center providers who work with these families. Minneapolis Early Intervention Committee Identifies areas of service needs. Works closely Minneapolis Health Department with support staff delivering information and Minneapolis Public Schools Early Childhood referral services. Family Education Program Minneapolis Public Schools Special Education Programs 1 FTE Education/Training Coordinator: Minnesota Association for the Education of fi3 Young Children Responsible for w ordinating pre-service and in- WAY TO GROW

37 service training of paraprofessional home Minneapolis Early Intervention Committee, staff visitors. Offers consultation to other early of public and private agencies and organizations childhood service providers in Minneapolis. citywide, and the general public are illustrated in Promotes and develops pre-service and Figure 5.1. continuing education modules on early childhood issues for professionals from other human service disciplines. Designs public information efforts in cooperation with Communications Coordinator. Works cooperatively with other Timeline training agencies and consultants citywide. The suggested timeline for the start-up of Way to Grow and the home visit expansion is 1 FTE Corirmunications Coordinator: shown in Ague 5.2. The tasks listed in the left column would be undertaken by the Way to Responsible for citywide outreach for Way to Grow Management Board and staff unless Grow. Assists community collaboratives in identified otherwise. Community linkages and developing local outreach plans for their home Public Education/Outreach (Components 1 and 3) visit expansion. Responds to requests for would begin in December 1988 and be ongoing. information about Way to Grow. Works Way to Grow home visits to families by closely with Education/Training Coordinator in trained paraprofessionals would begin in January public education efforts. 1990, with interim time devoted to requests for proposals, proposal planning and technical assistance, proposal review, set-up, and training 1 FTE Planning/Evaluation Coordinator: for home visitors. This amount of time is necessary for effective implementation of the Responsible for designing and implementing Way to Grow home visit expansion. research and evaluation efforts in collaboration with Prograin Director, other Way to Grow Timelines for other Way to Grow staff, and consultants. Assists community activities would be established by its collaboratives in planning data collection efforts. Management Board, based on priorities which Responsible for annual planning and reporting emerge from work performed for Component 1, process, in cooperation with Program Director Community Linkages. and other Way to Grow staff.

1 FTE Administrative Assistant: Costs and Funding Responsible for overall office management and operation of computerized referral system. The estimated annual cost for the central Supervises office support persons. Works office and staff for Way to Grow is between closely with Program Director. $360,000 and $495,000. This includes five professionals and three support staff; contracted services (for training, research and evaluation 2 FTE Office Support Persons: design, data collection, etc.); and miscellaneous expenses such as computer hardware, software, Respond to telephone requests for information and other equipment, printing, telephone, from families and service providers. Perform postage, office rental, etc. (See Figure 5.3.) clerical tasks for Way to Grow staff. Based on an approximate number of 28,000 children ages birth through four in Minneapolis, Relationships among the Minneapolis this is an annual cost of less than $16 per child. Youth Coordinating Board, Way to Grow Management Board, Way to Grow staff, Initially, these funds should be sought 39 Figure 5.1 WAY TO GROW

Relatfonship of Way to Grow to Established Boards, Agencies, and Constituencies

School District

Minneapolis Youth Coordinating Board

Way to Grow Management Board

Way to Grow Staff

Minneapolis Early For Profit Intervention Agency/Organization Committee Staff

Way to Grow Information and Referral Network am am am en lam ow awl Community Collabo- ratives for Home Visit Expansion Public Non-Profit Agency/Organization Agency/Organization Staff Staff

40 Figure 5.2 WAY TO GROW

Way to Grow Start-up Timeline

39 1987 1988

DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Minneapolis Youth Coordinating Board process Report

Minneapolis Youth Coordinating Board seeks

foundation and/or governmental support for II II Way to Grow staff and central office staff Minneapolis Youth Coordinating Board assembles Way to Grow Management Board

Way to Grow Management Board hires Way to Grow Program Director II

Hire other Way to Grow staff; Finalize commit- ment of foundation and/or government support for planning grants and home visit system Prepare proposal application materials for planning grants and home visitor proposals; panning for ill cornmun9 linkages & public education, outreach nirquest tor proposals and awards for planning grants for home visitor proposals; begin community linkages (Dngoing); beginpublic education/outreach (ongoing) Community agencies plan home visit proposals; Technical assistance to proposal writiers; Des' n evaluation

Review/award home visit grants

Cc mmunities set up home visit systems; Design training for home visitors

Home visitor training begins

Home visits begin

41 Figure 5.2 WAY TO GROW

Way to Grow Start-up Timeline (continued)

1589 1990 mom JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN

Minneapolis Youth Coordinating Board process Report

Minneapolis Youth Coordinating Board seeks foundation and/or governmental support for Way to Grow staff and central office staff Minneapolis Youth Coordinating Board assembles Way to Grow Management Board

Way to Grow Management Board hires Way to Grow Program Director

Hire other Way to Grow staff; Finalize commit- ment of foundation and/or government support for planning grants and home visit system Prepare proposal application materials for planning grants and home visitor proposals; planning for communIn es & brc education/outreach equest or proposa aaw sr mg grants for home visitor proposals; begin community linkages (ongoing); beginpublic education/outreach (ongoing) Community agencies plan home visit proposals; Technical assistance to proposal writiers; II Design evaluation

Review/award home visit grants

Communities set up home visit systems; Design training for home visitors

Home visitor training begins I

Home visits begin II

42 WAY TO GROW

- 41 Figure 5.3 primarily from private foundations, since they are new expenditures and have the potential of effecting systemic change in the way families are Way to Grow Central Office served in this city. Foundation support could be Estimated Budget conditional on development of a plan for conversion to "hard" funding within five years. Salaries This plan would identify means of ongoing public and private support. Program Director $40,000-55,000 Community Linkages Coordinator30,000- 45,000 The average annual cost per community Edwationaraining Coordinator 30,000- 45,000 to implement the expanded home visit services is Communications Coordinator 25,000- 40,000 estimated at about $220,000 to $255,000. This Planning/Evaluation Coordinator 25,000- 40,000 includes salaries for a public health nurse, social Administrative Assistant 20,000- 35,000 worker, a halftime Early Childhood Family 2 Office Support Persons 30,000- 60,000 Education teacher, a community organizer/outreach worker, one clerk, six Fringe Benefits paraprofessional home visitors, and computer capacity. (See Figure 5.4.) It should be pointed Health, Dental, Life 21,000- 21,000 out that up to $80,000 of this may not require FICA (7.2%) 14,400- 23,040 any new money, but be covered by reassigning Workers Compensation (1%) 2,000- 3,200 currently employed personnel to new community Staff Development (2%) 4,000-6,400 locations.

Other Expenses Full-time home visitors would be expected to visit four families per day for four Contracted Services (Research days of the week, with the fifth day devoted to Design, Data Collection, record-keeping, staff meetings, etc. Staff Training, etc.) 30,000 - 30,000 development would be scheduled periodically Mileage @ $0.21 Per Mile/Parking3,5C0 - 3,500 during time usually allocated for home visits. Office Rental Sixty-six home visitors citywide should be able (3,000 sq. ft. @ $7 per sq. ft.)21,000- 21,000 to handle the approximate 6,600 births per year, Telephone 1,900-1,900 since the service is voluntary and not all families Copying 5,000- 5,000 will choose to participate. The number of home Printing/Keylining 35,000- 35,000 visitors in each of the 11 communities will vary, Postage 5,000- 5,000 however, based on need and demand within each Materials and Supplies 2,500- 2,500 community. This means that the budgets will Equipment 2,500- 2,500 also vary from one community to another. Multi-User Microcomputer with 3 Terminals, Printer, Initial potential funding (dollar and/or in Software, and Training 15,000- 15,000 kind) sources for Way to Grow could include: private foundations, both Minnesota foundations and others; Minneapolis Public Schools Early TOTAL $362,800 - 495,040 Childhood Family Education and Early Childhood Special Education; Hennepin County Community Services Department; and Minneapolis Health Department.

Federal funding possibilities for these and other Way to Grow activities include sources such as: Maternal and Child Health Block Grant; WIC; Head Start; Medicaid; Even Start; Child 3 Abuse and Neglect Prevention and Treatment WAY TO GROW

Act; National Institute of Child Health and 42 Figure 5.4 Human Development; U.S. Departments of Health, Human Services, Agriculture, and Education; Public Law 99-457; National Institute Way to Grow Community of Mental Health; and Title XX. Collaboratives Average Estimated Budget At full implementation, employing 66 paraprofdssional visitors citywide, with a professional supervisory team, support staff, and related expenses in each of 11 communities Public Health Nurse $25,000 - 32,000 citywide, the total annual cost would be about Social Worker 25,000 - 32,000 $2.8 million for the home visit component. 0.5 Early Childhood Family (Again, not all of this should require new Education Teacher (Tuts) 16,000 - 16,000 money.) This averages about $400 per newborn, Community Orgaidzer/ or $100 per child birth through age four in Outreach Person 14,560 - 20,800 Minneapolis. This system has the potential, 6 Home Visit Ors @ $14,560 Each however, for performing outreach, basic .(average number per screening, and preventive programming for community) 87,360- 87,360 public and private service agencies citywide. Office Support Person 14,560- 20,800 Fringe Benefits @ 20% 36,496- 41,792 For the first operating year, if the home Terminal and Modem to Link to visit expansion is phased in at four of 11 Central Computer 1,000- L000 community sites, the total cost would be less than Telephone 1,600-1,600 $1.5 million, including all costs of the central bfileage/Paricing 2,000- 2,000 Way to Grow office, and 11 planning grants at $3,000 each (a one-time cost).

TOTAL $223,576 - 255,352 Chapter 6 WAY TO GROW

Some Issues

43 identify and remedy conditions which Issues Regarding hinder or prevent the community's youth from becoming healthy, productive Organizational Structure members of society.

It is difficult to conceptualize an Three issues emerge when considering organizational structure when planning a system the MYCB as lead agency. The MYCB has not that involves the collaboration of severa's major been perceived as an organization involved in institutions and the cooperation of many direct service; its membership does not include individual players. In the case of Way to any non-public representatives; and its focus is Grow, the major institutions are the Minneapolis on youth from birth to age 20. Public Schools, Minneapolis Health Department, and Hennepin County. However, a wide variety Another option could be to create a new of public, nonprofit, and for profit agencies and public/private nonprofit agency whose sole organizations are involved as additional players. purpose would be the implementation of Way to Therefore, when alternatives for the so-called Grow. There was almost no support for this "lead agency" were examined, none of these option from our respondents. They felt that the agencies seemed appropriate. Each of the three new agency could become a new bureaucracy major collaborators has an already established with questionable operating authority. mission, clientele, and public image. Way to Grow must have its own identity in order to Therefore, this plan suggests that the succeed in serving all families of children pre- MYCB assume organizational responsibility for birth through age five. Additionally, if any one the implementation of Way to Grow. To of these institutions assum :d principal address the limitations of this option, the MYCB responsibility, it would be natural for the other would appoint a Management Board composed two, as well as other agencies and the general of public and private providers and consumers to public, to assume that ultimately Way to Grow hire staff and to direct Way to Grow operations. was a Health or Public School or County This proposal seems to maximize the advantages program. This could impair the collaboration and minimize the disadvantages of all available required for Way to Grow. choices. The Minneapolis Youth Coordinating Board (MYCB) appears to be a logical group to implement Way to Grow. Language in the 1985 joint powerS agreement among Hennepin Issues Regarding Mobility County, the City of Minneapolis, the Minneapolis School District, the Minneapolis During our interview process, many Park and Recreation Board, and the Minneapolis respondents expressed concern about two related Library, which establishes the Minneapolis issues which act as barriers to effective service Youth Coordinating Board, reads as follows: delivery:lack of transportation to services and residential mobility. Families with infants and It is the purpose of the Parties to this small children without access to a car are at the Agreement in creating a Youth mercy of the elements year-round while waiting Coordinating Board to improve the ability for and transferring between buses to get to their of public agencies and services to destinations. This takes a fairly high level of promote the health, safety, education, and motivation to surmount. Some parents will opt development of the community's youth out of the struggle and not participate in and to create an organizational structure to preventive health care for themselves or their improve coordination among the agencies children, to say nothing of other community and services and to accomplish that services such as parent education. objective by strengthening cooperation and providing an improved means to The second issue relates to the fact that A r-some families, for a variety of reasons usually tf5 WAY TO GROW

44 related to poverty, move frequently from one improvements in the development and education living situation to another. It can be very difficult of disadvantaged children that does not recognize for service providers to reach or stay in touch the need for additional resources overa sustained with these parents and children. period is doomed to failure."' Since Way to Grow is designed to prevent deterrents school Way to Grow has no easy answers to readiness, locating the funds may be a challenge. these issues because none exist. However, it Prevention is not glamorous or dramatic, justas would address them through its diverse routine prenatal care seems a bit "ho-hum" management board; its expansion of home visits; compared with the dramatic life and death its promotion of community locations for activities of a neonatal intensivecare nursery. delivery of a wide variety of services; its referral Yet there is no question that the per personcost network for public and private agencies; and its of preventive care or education is less than coordinated approach to resolving problems in rehabilitative and therapeutic approaches. service delivery. For instance, prenatal care (excluding Related to the client mobility issue is the labor and delivery) costs about $400, compared interest of some providers in the establishment of with an average of $14,700 for each low birth a tracking system for infants, children, and weightinfant.4 The latter figure refers only to families. Models for such systems exist in North costs of neonatal intensive care services, and Carolina and other states and are embryonic does not include any other costs related to within agencies here in Minnesota. Many disabilities resulting from low birth weight. A questions arise when conceptualizing a tracking $1.00 investment in quality preschool education system which could be used across a variety of returns $4.75 because of lower costs of gpecial agencies. These include: Whit kinds of data will education, public assistance, and crime." It is be collected and in what form? Who will handle reasonable to assume that over time, investment the data? Who will have access to the data? in Way to Grow will allow us to recycle How will access be controlled? How long will increasing amounts of money from treatment into data be retained? How will family and individual prevention, with better results and eventualcost rights to privacy be protected? How will returns. individual agency autonomy be balanced with collective data management? These and other Prevention is a quiet approach to human questions were not resolvable within this six- problems. It is also an eminently sensibleone. month pimping period. The public has accepted basic health and sanitation procedures to prevent or limit disease. The Minneapolis Health Department has Yet there continues to be reluctance to invest in been meeting with State Health Department broad prevention activities for the general officials regarding development of a tracking population to assure school readiness,as well as system in Minneapolis. The Way to Grow to prevent school failure, teen pregnancy, Management Board could participate actively in juvenile delinquency, and child abuse and any collaborative development of a tracking neglect. In 1986, the nation spent $264 billion system with these and other agencies. on education for children age six and older, while it spent only about $1 billion fqr educating children age five and younger.But as the Committee for Economic Development states: Cost Issues Failure to educate is the true expense--for The activities proposed for the Way to both society and individuals. The most Grow system, as well as the central office and recent estimates suggest that each year's staff to implement those activities, willcost class of dropouts will cost the nation money. As the Committee for Economic more than $240 billion in lost earnings Development points out: "Any plan for major and foregone taxes over their lifetimes. This does not include the billionsmore WAY TO GROW

45 for crime control and for welfare, health care, and other social services that this group will cost the nation?

The costs in human suffering of school failure and all its attendant problems are immeasurable. It's time to follow through when we say that our children are our greatest resource. It's time to ride the current wave of interest in early childhood issues from both the public and private sectors nationwide. It's time to listen to the overwhelming support of those involved in the planning process for Way to Grow over the past six months. It's time to listen to the children. Appendix A WAY TO GROW Acknowledgments

46 The following persons were consulted in the preparation Bob Brancale Minneapolis Public Schools of this plan. Although they are not responsible for Early Childhood Family statements made in this report, their gracious and generous Education Program participation ih the planning process profoundly shaped Karen Braye Minneapolis Urban Lugue the product. For that we are deeply grateful. Aviva Breen Commission on Economic Status of Women David Allen Resources for Child Caring Mavis Brehm Minneapolis Children's Cordelia Anderson Illusion Theater Medical Center Dale Anderson Greater Minneapolis Day Care Judith Brown Minneapolis Public Schools Association Special Education Programs Mark Andrew Hennepin County Board of Louise Brown Minneapolis Family and Commissioners Children's Service Carol Arthur Childbirth Education Mary Dooley Burns Vdcational Education Work and Association Family initiative Mary Madonna Ashton Minnesota Department of Pat Buschmann Lutheran Social Service of Health Minnesota David Aughey Teenage Medical Servicd Maureen Cannon Children's Trust Fund (TAMS) Ann Carlson Family Education Associates Anita Baccus Southside Community Clinic Geraldine Carter Survival Skills Institute Nancy Banchy Minneapolis Public Schools Veronica Chatterton Sabathani Community Center Teen Parent Program Lynn Choromanski Group Health Inc. Gina Barclay The Center for Successful Andrea Christianson Child Net Child Development John Clausen Minnesota State Council for (Beethoven Project), Chicago, the Handicapped Illinois Pam Coaxum Dayton Hudson Foundation Terri Barreiro United Way of Minneapolis Barry Cohen United Way of Minneapolis David Beer Erikson Institute for Advanced Sheila Cohen Minneapolis Crisis Nursery Study in Child Development, Charlene Cole Pilot City Regional Center Chicago, Illinois James Cook Sabathani Community Center Nancy Belbas Minneapolis Children's Kathy Cook Cedar Riverside People's Medical Center Center Connie Bell Greater Minneapolis Day Care Kathleen Corrigan Project Dakota Outreach Association Debra Cottone Hennepin County Kenyari Bellfield Urban Coalition Wayne Cox Minneapolis Community Peter Benson Search Institute Business Employment Carol Berde The McKnight Foundation Alliance Kathryn Berg Minneapolis Children's Sharon Cross Minneapolis Health Medical Center Department Linda Berglin Minnesota Senate Patricia Cummings The Minneapolis Foundation Ann Bettenburg Minnesota Department of Mary Jo Czaplewski Minnesota Council on Family Education Relations Leslie Blicker COmmunit5, Clinic Anne Damon Minneapolis Health Consorthini Department Trish Blomquist Early Childhood Studies Heidi Depue Minneapolis Children's Program, University of Medical Center Minnesota Nancy Devitt Hennepin County Office of John Bluford Hennepin County Medical Planning and Development Center Tom Dewar Hubert H. Humphrey Institute Jean Blum Beltrami Health Center of Public Affairs, University Margaret Boyer Child Care Workers Alliance of Minnesota Lane Ann Dexter Louise Whitbeck Fraser Community Services 43 WAY TO GROW

47 George Dilliard Glenwood Lynda le Community James Garbarino Erikson Institute for Advanced Center Study in Child Development, Alyce Dillon PICA Head Start Chicago, Illinois Kathleen Dineen University of Minnesota Susan Gardebring Minnesota Department of Midwifery Human Services Ed Dirkswager Group Health Inc. Mae Gaskins Minneapolis Public Schools Paul Dokecki Vanderbilt University, John Gehan Child Care Works Nashville, Tennessee Scott Giebink Minnesota Chapter of Mary Ellen Dumas Division of Indian Work American Academy of Cynthia Ea ley Child Care Resource Center Pediatrics Nancy Edwards Pillsbury United Neighborhood Scotty Gillette Mayor's Office, City of Services Minneapolis Byron Egeland Mother-Child Interaction Mary Lou Gilstad Early Childhood Studies Project, University of Program, University of Minnesota Minnesota Edward Eh linger Minneapolis Health Doug Goke St. Joseph's Home for Children Department Marge Goldberg PACER Center, Inc. Ann Ellwood MELD Paula Goldberg PACER Center, Inc. Lois Engstrom Minnesota Department of Richard Gleen Minneapolis Public Schools Education Lee Greenfield Minnesota House of Sharon Enjady Minnesota Indian Women's Representatives Resource Center Jim Greenman East Side Neighborhood Susan Erbaugh Minneapolis Children's Services Medical Center Anne Griffith Hennepin County Community Martha Farrell Erickson Project STEEP, University of Health Minnesota Julie Ha lla Obstetrics Clinic, Hennepin Jeri Ezaki Neighborhood Involvement County Medical Center Program Karin Hangsleben American College of Nurse Judy Farmer Minneapolis Board of Midwives Education Ranae Hanson Nelson, Whiteford, and Sylvia Farmer Greater Minneapolis Council Associates of Churches Donna Harris Minneapolis-Employment and

Kerry Felt Shingle Creek Early Learning Training Program , Center Larry Harris Minneapolis Public Schools Martha Finne Responses to End Abuse of Terri Haveman Junior League of Minneapolis Children Linda Haugen Southside Family Nurturing Florence Finnicum Child Behavior and Learning Center Clinic, Hennepin County Diane Hedin The Pillsbury Company Medical Center Lynn Heibel Children's Home Society of Robert Fisch Pediatrics Department, Minnesota University of Minnesota DeLais Henderson Survival Skills Institute Ema Fishhaut CEED, University of Shirley Henderson Project Self-Sufficiency Minnesota Monica Herrera Hispanic Women's Barbara Flanigan League of Women Voters of Development Corporation Minneapolis Ruth Hi land Southwest MICE Program Betty Flanigan Minneapolis Health Jan Hive ly Mayor's Office, City of Department Minneapolis Donald Fraser Mayor's Office, City of Jeannette Honan Group Health Inc. Minneapolis Alice Sterling Honig Syracuse University, Syracuse, Rosemary Froehle Courage Center New York

Mario Galindo Centro Cultural Chicano Carol Hood Minneapolis Early Intervention . Committee 49 WAY TO GROW

Jonathan Hubschman Citizens League Bobby Lay Sabathani Community Center Don Ims land Minnesota Project for Irving Lazar Cornell University, Ithaca, Corporate Responsibility New York Harry Ireton Family Practice and Lefty Lie Metropolitan Visiting Nurse Community Health, Association University of Minnesota Beth Lilleveld Childrens Home Society Beverly Jackson CHART Ann Lonstein National Council of Jewish Elizabeth Jerome Minneapolis Children's Women Medical Center David Lurie Minneapolis Health Clare Jewell Minneapolis Public SchoOls Department Early Childhood Family Alice Lynch BIHA-Women in Action Education Program Ella Mahmond Black Child Development Helen Jirak Northside Child Development Impact Project Center Richard Mammen Minneapolis Youth Ann Johnson Minneapolis Urban League Coordinating Board Curtis Johnson Citizens League Mary Martin Shared Care Project, Hubert H. Margaret Johnson Minneapolis Federation of Humphrey Institute of Public Teachers Affairs, University of Marlene Johnson Lieutenant Governor's Office, Minnesota State of Minnesota Pamm Mattick Child and Family Studies, St. Nancy Johnson Southside Child Cam Cloud State University CoMmittee Doima McClellan Minneipolis Public Schools Susan Johnson-Jacka The Learning Tree Mike McGraw Hennepin County Community Betty Kaplan Ramsey County Public Health Services Department Carolyn McKay Maternal and Child Health Carol Kaste Washburn Child Guidance Division, Minnesota Center Department of Health Therese Kelliher Incarnation House Daniel McLaughlin Hennepin County Medical Anne Kelly Finance Department, State of Center Minnesota Diane Mc Linn Audubon Early Learning Cindy Kelly Greater Minneapolis Day Care Center Association Larry Mens Mi.. Jta Committee for the Kevin Kenney -Hennepin County Community Prevention of Child-Abuse Services Kim Merriam United Way of Minneapolis Kim Keprios Association for Retarded David Mersey Minnesota Academy of Family Citizens of Hennepin County Physicians Ann Kincaid Preschool Mental Health Sara Messelt March of Dimes Birth Defects Program, Minneapolis Foundation, Greater Twin Children's Medical Center Cities Rick Kleinschmidt Hennepin County Special Janet Midtbo League of Women Voters of Needs Daycare Minneapolis Ted Kolcierle Hubert K Humphrey Institute Carol Miller Hennepin County Community of Public Maki, University Services of Minnesota Johanna Miller Pilot City Health Center Kathy Kossila Shingle Creek Early Learning Mona Moede Sumner Olson Residence Center Council Chyrrel Krivit Fremont Community Health Judy Mogelson Pilot City Health Center's Services North High School Mini - Keith Kromer Minneapolis Public Schools Clinic Michael LaBrosse Human Development Industries Dorothy Mollien Reuben Lindh Learning Center Marilyn Lantry Minnesota Senate Corinna Moncada Minnesota Department of Nancy Latimer The McKnight Foundation Education 50 WAY TO GROW

49 Shirley Moore Institute of Child Board Development., University of Judson Reaney Minneapolis Children's Minnesota Medical Center Pamela Morford Obstetrics/Gynecology Private Jacqueline Reis Minnesota Council on Practice Foundations Sheila Moriarty Minnesota Council on Ilene Rice Maternal and Child Health Children, Youth, and Education Families Karen Ringsrud League of Women Voters of Mary Morris-Leadholm Catholic Charities of the Minneapolis Archdiocese David Rodboume Spring Hill Center Lee Ann Murphy Pillsbury United Neighborhood Susan Roth Family and Children's Service Services, Inc. Jan Rubenstein Minnesota Department of Scott Neiman Minneapolis Park and Education Recreation Board Maria Cruz Rubin Community-University Health David Nelson Nelson, Whiteford & Care Center Associates Claire Rumpel Minnesota Department of Eloise Nelson Audubon Early Learning Education Center Brian Russ Mayor's Office, City of Ken Nelson Minnesota House of Minneapolis Representatives Anne St. Germaine Special Education Service William Nersesian Southdale Medical Building Center Zoe Nicholie Quality Infant Toddler Elaine Salinas Urban Coalition Car. Project -- GMDCA Sharon Say les-Belton Minneapolis City Council Karen Norsby Hennepin County Medical C. Edward Schwartz University of Minnesota Society Hospitals and Clinics Ken Northwick Minneapolis Public Schools Duane Scribner Business Action Resource Luanne Nyberg Children's Defense Fund Council Charles Oberg Minneapolis Health Fern Scpler-King Crime Victims Witness Department Advisory Cc tmcil Barbara O'Grady Ramsey County Public Health Sharlene Shelton Courage Center Joanne O'Leary Abbott-Northwestern Hospital Sam Sivanich Hennepin County Board of Allen Oleisky Hennepin County District Commissioners Court, Juvenile Division Nan Skelton Minnesota Department of Rosemary O'Meara Urban West Central YMCA Education Aileen Okerstrom WINGS Phyllis Sloan Mary T. Wellcome Child Peg O'Shaughnessy Minneapolis Public Schools Development Center John Oswald Group Health Inc. Chuck Slocum Minnesota Business Jolene Pearson Minneapolis Family School Partnership Donna Peterson Minnesota Senate Holly Smart Chrysalis Center for Women Sandra Peterson Minnesota Federation of Marty Smith Minnesota Department of Teachers Health Ron Pitzer Minnesota Extension Service, Norine Smith Indian Health Board University of Minnesota Lucille Soli Consultant Janet Proehl Ramsey Preschool Rosemary Sommerville Education Finance Division, Beverly Propes Con Sultant Minnesota House of Lois Quoin Med Centers Health Plan Representatives Kathy Ramisch The Pillsbury Company Alan Sroufe Mother-Child Interaction Ruth Randall Minnesota Department of Project, University of Education Miimesota Gladys Randle Phyllis Wheatley Community Diane Stoltenberg Southside Family Nurturing Center Center Rip Rapson Minneapolis Public Library 51 WAY TO GROW

50 Louise Sundin Minneapolis Federation of Teachers Jerri Sudderth Minnesota Department of Human Services Karen Swanson Minneapolis Visiting Nurse Association Mary Taylor Harriet Tubman Battered Women's Shelter Linda Thompson Hennepin County Medical Center Stuart Thorson Family Medical Center David Tilsen Minneapolis Board of EducatiGn Jocelyn TiLsen Parents Anonymous Linda Todd Abbott-Northwestern Hospital Hoang Tran Centre for Asians and Pacific Islanders Rachel Trockman Child Behavior and Learning Clinic, Hennepin County Medical Center Gail Tully Birth Community Owen Turnlund Minneapolis Federation of Alternative Schools Gene Urbain Wilder Foundation Prevention Planning Team Jeremy Waldman Jewish Family and Children's Services Michael Weber Hennepin County Community Services Ellie Webster Indian Health Board Heather Weiss Harvard Family Research Project, Cambridge, Massachusetts Mike Welsh Genesis II for Women, Inc. Larry Wicks Minnesota Education Association Katie Williams Minnesota Association for the Education of Young Children Young Women's Christian Association of Minneapolis Faye Wooten Survival Skills Institute Ellen Wuertz Health Etc. Clinic Ann Wynia Minnesota House of Representatives Patty Yeager St. Anthony Developmental Learning Center Sue Zuidema Community Health Department 52 6

Appendix B WAY TO GROW Discussion Questions for Structured Interviews June and July 1987

1. What do you see as your organizational mission?

2. What do you feel are the biggest barriers to your accomplishing this mission?

3. Think about a success story relative to your mission -- an individual who benefited from your (agency's) services or something that worked well for you. What do you think led to this success?

4. If you were to design a plan for comprehensive, coordinated services for Minneapolis families and their children, prebirth to age six, how would you define the target population?

5. What would you include in this plan?

6. How would you make sure that these services reach the target population as you define it?

53 Appendix C WAY TO GROW Reprint: "Focusing on Prevention in the First Sixty Months"

.5 4

Reprinted with permission from the National Center for Clinical Infant Programs, 733- 15th Street NW, Suite 912, Washington, D.C. 20005 (202/347-0308). First, human barriers often share common root Point of View causes including unmet needs for food, clothing, shelter Focusing On Prevention In The First and medical care, and inadequate basic aademic skills, leading to diminished self-esteem and life options. Sixty Months Second, the earlier intervention begins the more by likely it is to meet with success. Michael N. Castle Governor Of Delaware Chairman, Committee On Human Resources and Task Force On Welfare 53 Prevention, National Governors' Association The first sixty months are the most critical years in a person's life, a time when the foundations of personality, physique and character are developed. Yet, they are also 'le forgotten months, when many people unprepared for pregnancy andior lacking parenting skills, find themselves raising a child. The result, children who are not provided the important health, education and social opportunities needed to maximize their future potential. Problems not identified and addressed during this stage of life often cannot be completely and permanently corrected during adolescence and adult life. For that reason we need to change the focus of our present human and social service system which only addresses the symptoms of problems. By focusing on prevention and early identification of potential problems, by involving parents and others who have close contact with young children, we have the opportunity to treat the causes, to make good on the promise of opportunity for the next generation, and to remove barriers co self-sufficiency and productivity. As Chairman of the National Governors' Associa- A prevention strategy for young children tion's Human Resources Committee, I initiated an early For children, the challenge is to prevent the cycle childhood project entitled"Focus on the First Sixty of dependency from claiming another generation. Key Months" in the fall of 1985. The project grew out elements of a sound prevention strategy for children of my belief that we are not doing enough to solve include ensuring adequate health care, nutrition, family the problems associated with early childhood because nurturing, and educational, social, and physical we are still treating symptoms when we could as easily development. be attacking their causes. In February, 1986, the committee held a national conference, featuring Prenatal health care presentations by individuals from public and private Prenatal care, including medical care, nutrition, and healthy life habits, is truly an ounce of prevention worth institutions at the state and local levels. These speakers a pound of cure. Early and continuing maternity care described successful programs aimed at preventing is essential. It should include regular medical exams and health, education and social problems among children treatment, nutrition counseling and the food to provide zero to five years of age. (SeeZero to Three,September, a healthy diet, and safe and appropriate delivery and 1986 for the remarks of Irving B. Harris.) At the close support services. of the conference, I called on the NGA to develop a handbook of prevention activities for young children Children's health care to present to each Governor. In July, 1987 this report, Children need decent health care at every stage of Focus on the First Sixty Months,was published. development, and health care is critically important as At the same time, the nation's Governors concluded a transition service when individuals move from welfare a year-long effort of five task forces to develop dependency to self-sufficiency. Good health care begins comprehensive state action plans to enhance human with comprehensive care early in the mother's potential and bring down the barriers to self-sufficiency. pregnancy, throughout labor and delivery, and Two fundamental conclusions emerge in the report of continues throughout childhood, with a focus on the the five task forces,Making America Work: Bringing Down child's prevention, acute, and chronic health needs. the Barriers, Preventive and primary health care for children can September1987Zero to Three detect and treat problems that develop during infan-y. a state to sort out how many of its current resources Providing primary and preventive health care is can be devoted to true prevention relative to those expensive, but it costs lessboth in economic and directed at treatment. A continuum of prevention/ human termsto prevent illness and hunger than it intervention can be viewed as a triangle. does to treat the results. At a minimum, primary and preventive health care should include:

Well-baby clinics that provide early, periodic Treatment or Degree of screening, diagnosis, and treatment; Institutionalization W Intrusivene%% Full immunization against all preventable child- °4 hood disease; Supplemental nutrition assistance; Protective Medicaid coverage to women and young chUren Intervention Probiemleguo with family incomes less than the federal poverty .0,M1r:::: ... 11; . but over a state's AFDC eligibility levels; and Early Comprehensive adolescent health care services. Intervention At Risk Family resource programs The American family structure has changed over the Primary last fifty years, and many young parents feel a sense Prevention General Population of isolation and frustration as they try to work and successfully raise children. Parents need to know that they are not alone and that the larger community will support their efforts. Movement from the base of the triangle, the general Diverse, independently funded programs have quietly population, toits apex, severe problems, involves emerged in the last ten years in all kinds of communities smaller and smaller groups in the population bu: ever to address these needs. Family resource programs can increasing degrees of intrusion into a person's life. As offer parents education, information, advice, and problems become more severe, intervention strategies emotional support. Common characteristics of these become more intrusive, more costly, and less effective. programs include: child development classes; informa- Why does a focus on intensive treatment still persist tion and referral services; nutrition counseling; hotlines; in health and human services programs? First, there peer support groups; parent-child communication skills; are no advocacy groups clamoring for state government and positive discipline techniques. to appropriate funds for the general population. Yet, Child care through our past immunization programs, for example, Child care is a critical ancillary service as individuals fatal and crippling diseases such as diphtheria, peitussis, move from welfare dependency to independency. It is congenital rubella, smallpox, and polio were nearly also a critical element in a prevention strategy for eradicated. Nevertheless, for each of the past four years, children. Quality child care not only provides a safe the number of children immunized by public programs environment for children while their parents participate has dropped by at least 20 percent. Second, there is in training or work; it also offers valuable education a longer delay in demonstrable benefit from primary and social opportunities. prevention and early intervention than there is from What constitutes quality child care? Research protective intervention and treatment. Re:noving a suggests the following elements of a "quality" child care young child from an abusive home today and placing program: small group size, high staff-to-child ratios, him with a foster family is a short-term intervention good health and nutrition standards, parental involve- which can show immediate results. Sending family ment, and training requirements for caregivers. therapists to that same home for twenty hours per week Further, as child care strategies are developed, states for several months to prevent removal and placement need to address child care needs in a cohesive, is a lengthier effort. Waiting another six months for coordinated effort that uses unified standards of follow-up to demonstrate to legislators and others that availability, quality, and affordability. early intervention has workedthat removal remains unnecessaryrequires patience. Third, service provid- A continuum of intervention ers who have been trained to provide treatment and As a nation,we have tended to permit the tragedy of treatment needsthe crisisto overshadow the have spent their careers doing so, are not easily persuaded to become ardent supporters of prevention. potential of prevention. Governors, human service agencies, professionals, parents and citizens must begin Patterns of successful prevention to refocus their thinking and redirect some of their As the handbook Focus on the First Sixty Months w ?5 resources toward prevention programs for some of our prepared, diverse programs were identified from states youngest citizens. Refocused thinking depends upon a and localities in every part of the country that have working definition of prevention. This, in turn, helps taken a preventive approach and that show promise

Zero to ThreeSeptember1987 ,6 of success. The nineteen programs selected for inclusion in the handbook address child care, parent-infant relationships, the development of infants and toddlers with disabilities, teenage parents and their children, adoption of special needs children and health care for mothers and infants. A number of elements seem to be part of the pattern of success of these prevention efforts. Effective programs, we discovered: reach out to multiple agencies, whether public or private, in order to deliver an array of needed services; often go into families' homes, rather than expecting participants to report to agency offices; target multiple problems, albeit a single problem is the initial focus; mix funds from public and private, state and local Fources; include some evaluation effort, to measure the extent of the program's impact and learn whether or not the delivery model needs refinement; maximize parent involvement so parents ultimately can be the service providers and advocates for their children; and focus on the lower two rungs of the prevention trianglethe general and at-risk populationswhere the greatest benefit is likely to be achieved for the least cost and with the least intrusion. Conclusion Helping children and families to overcome barriers to healthy development and p:oductive self-sufficiency is a complex process. Multiple points of intervention may be required durin:a person's lifetime, with approaches from a variety Jf programs and institutions. Our Governors' focus en the first sixty months has convinced us that prevention must begin early, and that, to be effective, preventive approaches demand commit- ment and collaboration from all who care about our nation's children and their families. Our children are the world's greatest resource and our greatest hope for the future. Their ability to build a better future will depend on the foundation we lay for them.

Focus on the First Sixty Months: A Handbook of Promising Prevention Programs for Children Zero to Five Years of Age is a joint product of the National Governors' Association Committee of Human Resources and Center for Policy Research. The 43-page illus- trated publication is available for $12.50 per copy. Making America Work: Bringing Down the Barriers, contains an overview and reports from Governors' task forces on welfare prevention, school drop- outs, teen pregnancy, adult literacy and alcohol and drug abuse. The cost of the 133-page report is $15, with bulk rates available. Purchase orders or checks may be made payable to the National Governors' Association and sent to NGA, Hall of the States, 444 North Capitol Street, Washington, D.C. 20001-1572. September 1987 Zero to Three 7 Appendix D WAY TO GROW Partial List of Existing Services for Direct Service Continuum Prenatal and Preventive Health Care Childbirth Education

(includes immunizations, health education, and family Childbirth Education Association planning information.) Some health care provides

Abbott - Northwestern Hospital, Inc. Beltrami Health Center Cedar Riverside People's Center Transportation to Community Community-University Health Care Center Services as Needed Fairview Hospitals Family Medical Center Fremont Community Health Services Courage Center Group Health Inc. Family Medical Center Health Etc.Your Neighborhood Clinic Louise Whitbeck Fraser Community Services Hennepin County Child Health Clinic Indian Health Board of Minneapolis Hennepin County Medical Center Minneapolis Family School Indian Health Board of Minneapolis Minneapolis Health Department Med Centers Health Plan MICE Program PACE Program Metropolitan Medical Center Minneapolis Children's Medical Center PICA Head Start Minneapolis Health Department Pilot City Health Center Minneapolis Public Schools Adolescent Health Care Pilot City Regional Center Programs Ramsey Preschool North Memorial Medical Center Reuben Lindh Learning Center Park Nicollet Medical Center Survival Skills Institute Pilot City Health Center University of Minnesota Hospitals and Clinics Private physicians and health care providers Share Health Plan Southside Community Clinic Teen Age Medical Service (TAMS) Home Visits University` of Minnesota Hospitals and Clinics Uptown Community Clinic Courage Center Fraser School Group Health Inc. Healthy Beginnings Nutrition Information Hennepin County Community Services Department Home health services of hospitals and other private Birth Community Inc. agencies Healthy Beginnings Metropolitan Visiting Nurse Association Metropolitan Visiting Nurse Association Minneapolis Public Schools Early Childhood Family Minneapolis Health Department Education Program Minneapolis Public Schools Ramsey Preschool Minneapolis Public Schools Early Childhood Family Project STEEP Education Program Minnesota Extension Service, University of Minnesota PACE Program Phyllis. Wheatley Community Center Parent Education/Support for Pillsbury United Neighborhood Services Inc. Mothers and Fathers in Special Supplemental Food Program for Women, Infants Neighborhood and Workplace and ChildrenWIC Sumner -Olson Residents Council Abbott-Northwestern Hospital many health care providers WAY TO GROW

57 Catholic Charities Group Health Inc. Childbirth Education Association Minneapolis Children's Medical Center Children's Home Society of Minnesota Minneapolis Health Department Chrysalis Center for Women Minneapolis Public Schools Division of Indian Work Minneapolis Public Schools Adolescent Health Care Family and Children's Service Programs Genesis II for Women, Inc. Minnesota Department of Health Glenwood Lyndale Community Center Ramsey Preschool Group Health Inc. Reuben Lindh Learning Center Indian Health Board of Minneapolis University of Minnesota Hospitals and Clinics Lutheran Social Service Washburn Child Guidance Center March of Dimes Birth Defects Foundation many health care providers MELD .,- Metropolitan Visiting Nurse Association MICE Pmgram Minneapolis Area Vocational Technical Institute Child Care Minneapolis Children's Medical Center Minneapolis Public Schools Early Childhood Family Licensed centers and family day care homes throughout Education Program Minneapolisaffordability and quality vary and there is a Minneapolis Urban League Early Childhood and Family shortage of infant and toddler care citywide Education Program Minnesota Extension Service, University of Minnesota Neighborhood Involvement Program Options Program Special Needs Day Care PACE Program Parents Anonymous Children's Home Society of Minnesota Phyllis Wheatley Community Center East Side Neighborhood Service PICA Head Start Glenwood Lyndale Community Center Pillsbury United Neighborhood Services Inc. Hennepin County Special Needs Day Care in licensed Pilot City Health Center centers and family day care homes Pilot City Regional Center MICE Program Project STEEP Phyllis Wheatley Community Center Southside Child Care Committee YWCA Children's Center Survival Skills Institute Washburn Child Guidance Center YMCA YWCA many churches, hospitals, health care providers, preschool Respite Child Care/Crisis Nurseries and child care programs, and others Harriet Tubman Battered Women's Shelter Incarnation House Minneapolis Crisis Nursery Child Care Resource and Referral YWCA Children's Center

Greater Minneapolis Day Care Association Southside Child Care Resource Center Drop-In Centers for Parents and Children

Screening and/or Assessment Catholic Charities Glenwood Lyndale Community Center Child Behavior and Learning Clinic Fig WAY TO GROW

58 Minneapolis Public Schools Early Childhood Family some licensed nursery schools, child care centers, and Education Program family day care homes YWCA Children's Center

Assistance with Job Training/ Specialized Parent and/or Child Placement Skills for Parents Services/Classes Career Beginnings Catholic Charities Catholic Charities Centro Cultural Chicano Center for Asians and Pacific Islanders Children's Home Society of Minnesota Centro Cultural Chicano Family and Children's Service CHART Genesis II for Women, Inc. Family and Children's Service Glenwood Lynda le Community Center Katandin: A Workshop for Youth Greater Minneapolis Council of Churches Lutheran Social Service Lutheran Social Service Minneapolis Area Vocational Technical Institute MELD Minneapolis Employment and Training Program MICE Program Minneapolis Urban League Minneapolis Children's Medical Center Minnesota Indian Women's Resource Center Minneapolis Family School Neighborhood Employment Network Minneapolis Health Department Options Program Minneapolis Public Schools Early Childhood Family Phillips Job Bank Education Program and Special Education Programs PATHS Minneapolis Urban League Early Childhood and Family Pillsbury United Neighborhood Services, Inc. Education Program Project Self-Sufficiency Minnesota Indian Women's Resource Center Sumner-Olson Resident Council PACE Program WINGS Pacer Center Inc. YWCA Parents Anonymous PICA Herod Start Pilot City Health Center Preschool Mental Health Program Early Childhood Special Education Project STEEP and Therapeutic Southside Family Nurturing Center Survival Skills Institute PreschoaChild Care Washburn Child Guidance Center Courage Center Louise Whitbeck Fraser Community Services Minneapolis Children's Medical Center Developmental PreschooUChild Care Minneapolis Crisii Nursery North Metro Day Activities Center Audubon Early Learning Center PICA Head Start Genesis II for Women, Inc. Ramsey Preschool Phyllis Wheatley Community Center Reuben Lindh Learning Center PICA Head Start St. Anthony Developmental Learning Center Reuben Lindh Learning Center Southside Family Nurturing Center Shingle Creek Early Learning Center Survival Skills Institute Southside Family Nurturing Center Washburn Child Guidance Center Urban League Early Childhood and Family Education Program 60 WAY TO GROW

59 Therapeutic Parent and/or Child Services

Abbott-Northwestern Hospital Catholic Charities Children's Home Society of Minnesota Courage Center Crisis Intervention Services Division of Indian Work East Side Neighborhood Service Family and Children's Service Fremont Community Health Services Genesis II for Women, Inc. Group Health Inc. Harriet Tubman Battered Women's Shelter Hennepin County Communty Service Hennepin County Medical Center Hennepin County Mental Health Center Incarnation House Indian Health Board of Minneapolis Judson Family Center Louise Whitbeck Fraser Community Services Lutheran Social Service Minneapolis Children's Medical Center Minneapolis Crisis Nursery Minneapolis Fariiily School Minnesota Department of Health Minnesota Indian Women's Resource Center Neighborhood Involvement Program Parents Anonymous Private therapists and counselors Phyllis Wheatley Community Center Reuben Lindh Learning Center Southside Family Nurturing Center Survival Skills Institute Washburn Child Guidance Center

Individual Family Service Plans/Case Management

Courage Center Hennepin County Community Services Metropolitan Visiting Nurse Association Minneapolis Family School Ramsey Preschool Reuben Lindh Learning Center Southside Family Nurturing Center 6_> Appendix E WAY TO GROW List of Supporting Reports

City of Minneapolis Planning Department. State of the National Center for Clinical Infant Programs. Infants City 1986. Minneapolis, 1987. Can't Wait. Washington, D.C., 1986. Child Care Task Force. Making Child Care Work. St National Center for Clinical Infant Programs. Infants Paul: Minnesota Council on Children, Youth, and Can't Wait: The Numbers. Washington, D.C., 1986. Families, 1987. National Governors' Association. Focus on the First Committee for Economic Development. Children In Sixty Months: A Handbook of Promising Prevention Need: Investment Strategies for the Educationally Programs for Children Zero to Five Years of Age. Disadvantaged. New York, 1987. Washington, D.C., 1987. GAO. Early Childhood and Family Development National Mental Health Association. The Prevention of Programs Improve the Quality of Life for Low-Income Mental-Emotional Disabilities. Alexandria, Va., 1986. Families. (GAO/HRD-79-40). Washington, D.C.: The Plan of Action for Children. Chicago: The United States General Accounting Office, February Colman Fund, 1987. 1979. The Southern Corporate Coalition to Improve Maternal GAO. Prenatal Care: Medicaid Recipients and Uninsured and Child Health, Boardrooms and Babies: The Critical Women Obtain Insufficient Care. (GAO/HRD-87-137). Connection. Washington, D.C.: The Southern Washington, D.C.: United States General Accounting Governors' Association, 1987. Office, September 1987, The Southern Regional Task Force on Infant Mortality. Gillette, S. Three Plus: A Plan for Comprehensive, Final Report: For the Children of Tomorrow. Coordinated Intervention Dervices for "At Risk" Washington, D.C.: Southern Governors' Association, Children, Prebirth to Age Three in Minneapolis. 1985. Minneapolis Youth Coordinating Board, 1986. Women, Public Policy and Development Project. Shared Hobbs, N., Dokecki, P. R., Hoover-Dempsey, K. V., Care of Children. Minneapolis: Hubert H. Humphrey Moroney, R. M.; Shayne, M. W., and Weeks, K. H. Instimte of Public Affairs, October 1987. Strengthening Families. San Francisco: Jossey-Bass Publishers, 1984. League of Women Voters of Minneapolis. Should the Minneap9lis Public Schools Serve Four-Year-Olds? Offer Full Day Kindergarten? April 1987. League of Women Voters of Minneapolis. The Single Working Mother: Can She Make It? Minneapolis, 1980. League of Women Voters of Minnesota. Child Care in Minnesota: Public Issues. St. Paul, 1987. League of Women Voters of Minnesota. Health Care for Minnescp's Children: Investing In the Future. St. Paul, 19.s7. League of Women Voters of Minnesota. Protecting Minnesota's Children: Public Issues. St. Paul, 1986. Miller, C. A. Maternal Health and Infant Survival. Washington, D.C.: National Center for Clinical Infant Programs, 1987. Minneapolis Community Business Employment Alliance. Preventing, Unemployment: A Case for Early Childhood Education. Minneapolis, 1985. Minneapolis Health Department. Infant Mortality: The Problem in Minneapolis. Minneapolis, 1986. Minneapolis Planning Department. Minneapolis: Its Persistent Poor. Minneapolis, 1985. Minneapolis Planning Department. Supporting the Family: Toward Self - Sufficiency for Female-Headed Families in Minneapolis. Minneapolis, 1986. 62 Appendix F WAY TO GROW

Description of Minnesota's Early Childhood/Family Education Programs

Reprinted with permission from the from the Family Resource Coalition, 230 North Michigan Avenue, Suite 1625, Chicago, rilinois 60601(312/126- 4750). Tha Family Resource Coalition is a national network of people and organizations whichuses advocacy, public education, and publishing activities to promote the development of programs to strengthen families.

6° It'S a chilly February morning in CQE was established in 1971 to act as a of Minnesota's 435 school districts will be Minneapolis. The sidewalks and streets, wet source of state funds for helping local school offering Early Childhood Family Education from the previous week's thaw, are glazed districts try out cost-effective and innovative through their community education services. and treacherous. But:inside the Early ideas in all areas of education. The Council During 1985-86, it is estimated that 120,000 Childhood Family Education Center at reviewed proposals, awarded grants, provided parents and children will participate in Wilder Elementary School, a group of in-service training,, and monitored the growth programs at a predicted cost of $12,734,945, parents and their infants are attending the and expansion of programs during a ten-year through a combination of state aid and local levy. weekly "Babies" class. The activities begin period. Composed of nineteen members, the 62 with babies and mothers sitting ina circle on majority are appointed by the Governor from Program Perspective the floor singing a hello song to each child all areas of the state, with the remainder The central purpose of ECFE is to enhance and discussing any new developments that designated by various state educational and support the competence of parents in infant has made in the preceding week. The associations. providing the best possible environment for babies' eyes light up as group attention is focused upon eactrof them in turn. When the group separates, babies remain in the infant environment and parents go nearby to discuss topics they have mutually selected at the beginning of the eight-week class series. Both parents and baby groups are facilitated Minnesota Legislation by licensed parent educators and pre- kindergarten teachers. In Onamia, a small community located an Exemplary Commitment near the Mille Lacs Indian Reservation in north central Minnesota, Early Childhood to Families Family Education (ECFE) services involve family education sessions, home visits to by Karen Kurz-Riemer parents of infants, and special events offered at various community school sites, both in town and on the Reservation itself. Many of "The goals of Early Childhood Family Education are to: the-services emphasize Ojibwa cultural Support parents in their efforts in raising children awareness. Loans of toys and reading materials are available to help parents Offer child development information and alternative maintain a stimulating home environment parenting techniques for their children. These programs share the common goal of Help create effective communication between parents and strengthening families while illustrating some their children of the ways such a process can be introduced and assisted. Whether raising the self-esteem Supplement the discovery and learning experiences of children of children by the use of focused, individual Promote positive parental attitudes throughout their child's attention, or reinforcing parents through school years" peer support and information sharing, ECFE Minnesota Department of Education is helping parents provide for their.own and their children's learning and growing. The Minnesota Legislature, having recognized the connection between optimum child development and effective parenting, has initiated and gradually increased its support The Council was assisted in its the healthy growth of their children during for Early Childhood Family Education from administration of ECFE by a nine-member the formative years from birth to kindergarten pilot efforts to a statewide program Advisory Task Force, with a majority of enrollment. expansion. parents, and persons knowledgeable in the Each program is planned to be iocally fields of health, education, and welfare. controlled and responsive to the unique History of the Legislation Appropriations rose gradually from 1974 to needs of its community. In Minneapolis, for Minnesota's ECFE legislation was 1984, resulting in a growth of 6 to 36 pilot example, the monthly program newsletter developed by Senator Jerome M. Hughes. As programs located throughout Minnesota. In offers class opportunities such as: "Toddlers", its main author and a prevention proponent, fiscal '81, appropriations were tapped in the "Three to Five, Will I Survive?", "Single his attitude is. "A dollar spent early is the amount of $1,767,000; however, the money Parents", "Black Parents", "Raising best dollar spent, for the benefit of the child, crisis that occurred during the early '80s Brothers and Sisters", "Hmong Parents", the family and society. The money is returned recession resulted in a reduction of that "Blended Families", and "How to Talk So later through savings in the rehabilitation figure. Kids Will Listen". and repair budgets." In 1984, the Minnesota Legislature took a There are also listings of one-time events Originally passed in the 1974 session of the major policy step, transferring ECFE from such as field trips to a fire station, bakery, state legislature, an initial amount of $230,000 grant funding under the Council on Quality and flower show; speakers on topics ranging was appropriated to fund a minimum of six Education to formula funding through the from selecting child care to toilet training; pilot programs. Coordination of the program community education system. Community and a series of information nights at neigh- grants was entrusted to the Minnesota education funds include a mix of state and borhood schools for parents of prospective Council on Quality Education (CQE), which local dollars that maybe supplemented by kindergarten students. The program services has played a central role in ECFE's fees and funds from other sources. are offered at various locations throughout development. By the fall of 1985, approximately 60010 the city.

FAMILY RESOURCE COALITION REPORT - 1985 NO.1 *' 64 Although local programs vary in the income levels regardless of race, sex, age, or Encouraging parents to get involved early services they provide, 1985 Minnesota statute marital status. This universal intent, however, in the education cycle benefits everyonethe clearly states that subrantial parental requires strong and constant outreach efforts parents themselves who report increased involvement is required in all ECFE on the part of program staff. Word-of-mouth satisfaction in their roles, the children who programs: parents must be physically present has consistently been the most productive discover the joy of learning, the schools that much of the time in class with their children form of reaching families and this obviously gain greater parent participation, and the or in concurrent classes; parent or family requires competent, caring staff people and education system that becomes more cost- education must be an" integral part of every high quality programs. Staff members are effective. program; and that appropriations cannot be licensed parent educators and pre - It can take a long time, as it did in used fortraditional day care or nursery kindergarten teachers assisted by trained Minnesota, for policymakers to fully school programs. aides and volunteers. understand the concept of Early Childhood AddiIionally, local programs must closely Family Education. As Senator Hughes put it, Senator Jerome Hughes, developer of Minnesota's coordinate their services with those of other "Enduring change comes slowly." But ECFE legislation and currently President, community agencies in order to reach a Minnesota Senate. generally speaking, with understanding cross-section of their local population. comes support. And with that support, Parent advisory councils must be appointed grows an investment in human capital for each program with a majority of parent the children of today and the adults of members. Community persons from fields tomorrow. such as health, education, welfare, and child care are suggested for the remaining membership positions. The Research Base Helpful Information A Guide for Developing Early Evaluation efforts have been intensive since 1974, largely formative or process Childhood Family Education Programs (Cat. oriented in nature. These efforts, such as the MB518). Aimed at professionals in development of a comprehensive description parent education and program planning, this is a practical resource for starting programs of quality criteria for ECFE have been critical to the growth and development of the and running them on a limited budget. Extensive appendix with resources in program. Summative or outcome audio/visual materials for parent educators. evaluations, however, have been much more difficult. Voluntary participation and local Chapters on outreach, staffing, group programming variations in particular, along process, volunteers, community with the unperfected measurement of coordination, etc. Loose-leaf notebook parental "inputs" relative to child "outputs", format. Order from: Minnesota Curriculum Services Center, 3554 White Bear Avenue, have been problematic for research efforts. White Bear Lake, MN 55110, 612/770-3943. a Yet findings of the national Consortium for Longitudinal Studies and Michigan's Perry $16 ppd, $12 for MN residents. A Council on Quality Education Preschool Project strongly suggest positive publication long-term effects of a program such as titled, A Study of Policy Issues Related to Early Childhood Family Minnesota's Early Childhood Family Education. Education in Minnesotadetails the program's history, its base in research, Without specific, definitive research outcomes to promote the program, the evaluation strategies and results, and some reactions of parent participants to Early cost analyses. Available from: Lois Engstrom, Specialist, Early Childhood Childhood Family Education have been crucial These women and men have worked Family Education, Minnesota State Program Characteristics diligently over the past ten years, testifying Department of Education, 651 Capitol Square, St. Paul, MN 55101, 612/297-2441. Combinations of the following service before legislative committees, hosting components have become widely characteristic Programmatic concerns should also be policymakers at program sites, writing letters, addressed to Ms. Engstrom. of the programs: telephone calling, and generally lobbying for Requests for copies of the current Parent and family education through continued support and expansion of the Minnesota ECFE legislation and questions discussion groups, workshops, or home visits programs. Their efforts, along with those of on legislative issues can be addressed to: Parent-child interaction opportunities dedicated and competent local staff have Senator Jerome Hughes, 328 State Capitol, Guided play and learning activities for paid off for Minnesota families. children St. Paul, MN 55155, 612/296-4183. Early screening and detection of Investing in the Future chilcren's health and developmental problems Karen Kurz-Riemer is on parental leave as an At the same time ECFE programs see their instructors in St. Cloud State University's Center Lending libraries of books, toys, and ultimate benefit as strengthening families, for Child and Family Studies. She was Assistant other learning materials they are also reinforcing the role of parents Coordinator for the Minnesota Council on Special events for the entire family as teachers. There is enough data from the Quality Education from 1976 to 1982, working Information on related community Minnesota evaluations, and from similar intensively with the developing Early Childhood resources for families and young children programs around the country, to imply Family Education programs. A graduate of An important feature of Minnesota's potential for reducing later learning problems Chicago's Erikson Institute, Karen is working approach to Early Childhood Family of children. The research shows participating toward a doctoral degree in educational administration at the University of Minnesota. Education is its universal access. The children tend to require fewer special services programs must be offered on a voluntary She lives in Minneapolis and is the stepmother and experience more success during their of a son, 14, and mother of two daughters, 4 basis and are intended to reach parents of all school years. and 11 months.

') NO.1 1985 FAMILY RESOURCE COALITION REPORT WAY TO GROW

Endnotes

64 7. Edelman, M. W. Families in Peril: An Agenda lot- CHAPTER ONE Social Change. Cambridge, Ma.: Harvard University Press, 1987. 1. McClellan, D., Minneapolis Public Schools. Personal 8. Hughes & Rosenbaum, Non-Financial Barriers to Prenatal Communication, October 20, 1987. Care, 1987. 2. Committee for Economic Development Children in 9. Miller, C. A. Maternal Health and Infant Survival. Need: Investment Strategies for the Educationally Washington, D.C.: National Center for Clinical Infant Disadvantaged. New York, 1987. Programs, July 1987. 3. League of Women Voters of Minneapolis. Should the 10. Harris, L Letter to Mayor Donald Fraser, November 19, Minneapolis Public Schools Serve Four Year Olds? Offer 1986, describing Center for Successful Child Full Day Kindergarten? April 1987, p. 6. Development. 11. Hareven, T. K. "American Families in Transition: Historical Perspectives on Change." In F. Walsh (Ed.), Normal Family Processes. New York: Guilford Press, CHAPTER TWO 1982. 12. Garbarino et al. Children and Families in the Social Environment. New York: Aldine Publishing Company, 1. Preventing Low Birth Weight. Committee to Study the Prevention of Low Birth Weight, Institute of Medicine, 1982. Washington, D.C., 1985, p. 29. 13. Hareven, "American Families in Transition," p. 456. 14. Garbarino et al., Children and Families, 1982. 2. City of Minneapolis, Planning Department. State of the City 1987in preparation. 15. Tictjin, A. M. "Integrating Formal and Informal Support Systems: The Swedish Experience." In J. Whittaker 3. Presidcab Committee on Mental Retardation, Mental Retardation: Prevention Strategies that Work.. U.S. J. Garbarino (Eds.), Social Support Networks: Informal Helping in the Iluman Services. New York: Aldine Department of Health and Human Services, 1980, p. 7. 4. Bloom, Benjamin S. Stability and Change in Human Publishing Company, 1983. Characteristics. New York: Wiley and Company, 1964. 16. Kaplan, Lisa. Working with Multiproblem Families. 5. GAO. Early Childhood and Family Development Lexington, Ma.: D. C. Heath & Co., 1986. Programs Improve the Quality of Life for LowIncome 17. National Governors' Association Center for Policy Families. (GAO/HRD-79-40). Washington, D.C.: Research and Analysis. Time for Results: The United States General Accounting Office, February 1979, Governor's 1991 Report on Education. Washington, p: 23. D.C., August 1986. 18. Garbarino ct al., Children and Families, 1982. 6. Miller, C. A. Maternal Health and Infant Survival. Washington, D.C.: National Center for Clinical Infant 19. Garbarino, J., & Asp, C. E. Successful School.; and Programs, July 1987, p. 5. Competent Students. Lexington, Ma.: D. C. Heath & 7. Erikson News. Chicago, Summer 1987, p. 2 Company, 1981. 20. Ibid. 21. National Governors' Association, Time for Results. 22. Garbarino & Asp, Successful Schools and Competent Students, 1981. 23. Ibid. CHAPTER THREE 24. Bronfenbrenner, U. The Ecology of Human Development. Cambridge, Ma.: Harvard University 1. Hughes, D., & Rosenbaum, S. Non-Financial Barriers to Press, 1979. Prenatal Care. Prepared for the Institute of Medicine, 25. Garbarino ct al., Children and Families, p. 31. National Academy of Sciences, Prenatal Care Outreach 26. Garbarino ct al., Children and Families. Project, Washington, D.C. Children's Defense Fund, 27. Ramey, C. T., & Bryant, D. M. "Preventing and 1987. Treating Mental Retardation: Biomedical and Educational 2. Gillette, S. Three Plus: A Plan for Comprehensive, Interventions." In J. L. Matson & J. A. Mulick (Eds.), Coordinated Intervention Services for At Risk" Comprehensive Handbook of Mental Retardation. New Children, Prebirth to Age Three in Minneapolis. A York: Pcrgamon Press, in press. report prepared for Minneapolis Youth Coordinating 28. Garbarino et al., Children and Families. Board, December, 1986. 29. Ibid. 3. League of Women Voters of Minneapolis. Should the 30. Ibid. Minneapolis Public Schools Serve Four Year Olds? Offer 31. Ibid., p. 163. Ful7Day Kindergarten? April 1987, p. 6. 32. Garbarino ct al., Children and Families. 4. City of Minneapolis, Planning Department. State of the 33. Garbarino et al.. Children and Families. City 1986. January 1987. 34. Harris, Letter to Mayor Donald Fraser. 5. GAO. Prenatal Care: Medicaid Recipients and Uninsured 35. Albec, G. W., & Gulloua, T. P. "Facts and Fallacies Women Obtain Insufficient Care. (GAO/HRD -87 -137). about Primary Prevention." Journal of Primary Washington, D.C.: United States General Accounting Prevention, Summer 1986, 6, 207-218. Office, September 1987: 36. Ibid. 6. City of Minneapolis, State of the City 1986, 1987. 66 WAY TO GROW

65 37. Chamberlin, R. W. "Strategies for Disease Prevention 72. Warren, R. B., & Warren, D. LThe Neighborhood and Health Promotion in Maternal and Child Health." Organizer's Handbook NotreDame, In.: University of Journal of Public Health Policy,June 1984, 5(2). Notre Dame Press, 1977. 38. Garbarino et al.,Children and Families. 73. Brown,Child, Family, Neighborhood,p. 43. 39. Albce, G.W. "Toward a Jun Society: Lessons from 74. Garbarino et al.,Children and Families. Observations on the Primary Prevention of 75. Polansky, N. et al.Damaged parents.Chicago: Psychopathology."American Psychologist,August University of Chicago Press, 1981. 1986, 41 891.898. 76. Garbarino, J., Schellenbach, C., & Kosteleny, K.A 40. Cassell, J. "The Contribution of the Social Environment Model for Evaluating the Operation and Impact of Family to Host Resistance."American Journal of Epidemiology, Support and Child Abuse Prevention Programs in High- 1976,104, 107-123. Risk Communities.Draft. Prepared as part of a research 41. Albce & Gullotta, "Facts and Fallacies". project supported by the Illinois Department of Children 42. Consortium for Longitudinal Studies.As the Twig is and Family Services. Ericson Institute for Advinced Bent ... Lasting Effects of Preschool Programs. Study in Child Development. Unpublished manuscript, Hillsdale, New Jersey: Lawrence Erlbaum Associates, May 1987. 1983. 77. Garbarino et al.,Children and Families. 43. Chamberlin, "Strategies for Disease Prevention". 78. Whittaker, J. K. "Mutual Helping in Human Service 44. Institute of Medicine.Preventing Low BirthweigIst. Practice." In J. Whittaker & J. Garbarino (Eds.),Social Washington, D.C.: National Academy Press, 1985. Support Networks: Informal Helping in the Human 45. Miller,Maternal Health and Infant Survival. Services. NewYork: Aldine Publishing Company, 1983. 46. Chamberlin, "Strategies for Disease Prevention ". 79. League of Women Voters of Minnesota.Health Care for 47. Ibid. Minnesota's Children: Investing in the Future.St. Paul, 48. Long, B. B. "The Prevention of Mental-Emotional 1987. Disabilities: A Report from a National Mental Health 80. Hughes & Rosenbaum,Non-Financial Barriers to Prenatal AssociationCommission." American Psychologist,July Care. 1986, 41(7). 825.889. 81. Institute of Medicine,Preventing Low BirthweigIst. 49. Chamberlin, "Strategies for Disease Prevention ". 82. Hughes & Rosenbaum,NonFinancial Barriers to Prenatal 50. Chamberlin, "Strategic for Disease Prevention ", P. 190. Care. 51. Chamberlin, "Strategies for Disease Prevention ". 83. Miller, 1987, p. 4. 52. Brown, J. II. et al.Child, Family, Neighborhood: A 84. Hughes & Rosenbaum,Maternal Health and Infant Master Plan for Social Service Delivery.New York: Survival. Child Welfare League of America, 1982. 85. Ibid. 53. Kaplan,Working with Multiproblem Families. 86. Ibid. 54. Garbarino et al.,Children and Families. 87. Ibid. 55. Samcroff, A., & Chandler, M. "Reproductive Risk and 88. Ibid. the Continuum of Caretaker Causality."Review of Child 89. Poland, M. L, & GiAin, P. T.Personal Barriers to the Development Research,Vol. IV. Chicago: University Utilization of Prenatal Care.Review for Insitute of of Chicago Press, 1975. Medicine, Wayne State University, 1987. 56. Chamberlin, "Strategies for Disease Prevention ", p. 189. 90. Johnson, K.A Review of Studies on Barriers to Access 57. Chamberlin, "Strategies for Disease Prevention ". to Prenatal Care.Prepared for the Institute of Medicine, 58. Garbarino et al.,Children and Families. National Academy of Sciences, Prenatal Care Outreach 59. Chamberlin, "Strategies for Disease Prevention". Project. Washington, D.C.: Children's Defense Fund, 60. Garbarino et al.,1982. 1987. 61. Badger, E., & Bums, D. "A Model for Coalescing Binh- 91. Poland & Gblin,Personal Barriers. to-Three Programs." In L Bond & J. Joffe (Eds.), 92. Johnson,A Review of Studies on Barriers. Facilitating Infant and Early Childhood Development. 93. Poland & %lin,Personal Barriers. Hanover, New Hampshire: University Press of New 94. Halpern, R._Challenges in Evaluating Community-Based England, 1982, p. 514. Prenatal Care Outreach Programs.Working draft, April 62. Edelman,Families in Peril. 28, 1987. School of Social Work, University of 63. Maine Department of Education.Zero to Three Manual. Michigan. The Interdepartmental Coordinating Committee for 95. Johnson,A Review of Studies on Barriers. Preschool Handicapped Children. June, 1985. 96. Klennan, L V.Outreach for Prenatal Care: What 64. Harris, Letter o Mayor Donald Fraser. Works?Prepared for Institute of Medicine, Committee 65. Urbain, E., & Duke, T.Parent Outreach Project (P.O.P.). on Prenatal Care Outreach, May 1987. St. Paul: Wilder Foundation, 1986. 97. State of California.Final Evaluation of the Obstetrical 66. Brown,Child, Family, Neighborhood,p. 55. Access Pilot Project,January 1979-June 1982. 67. Brown,Child, Family, Neighborhood. December 1984. 68. Ibid. 98. Klemm,Outreach for Prenatal Care. 69, Brown,Child, Family, Neighborhood,p. 42. 99. Wright, T. D.Infant Health Promotion Coalition 70. Brown,Child, Family, Neighborhood. Report.Detroit, Mich. No date. 71. Brown,Child, Family, Neighborhood,p. 23. WAY TO GROW

66 100. Egdand, B., & Erickson, M. F.Psychologically 127. Lamer, M., & Halpem, R. "Lay Home Visiting Unavailable Caregiving: the Effects on Development of Programs; Suagtlu, Tensions and Challenges."Zero Yang Childs), and the Implications for Intervention. to Three,September 1987, 8(1). Paper praented at the International Conference at 128. Musidc & Stott, Handbook of Early Intervention. Psydiological Abuse, Indianapolis, 1983, p. 10. 129. Judge, G. "1Cnock, knock ... It's No joke."Zero to 101. Fran, S.Clinical Studies in Infant Mental Heal* Three,September 1987, 8(1). The First Year of Life.New York: Buie Books, 1980. 130. Kempe, C. H. "Approaches to Preventing Child Abuse." 102. Efickson & Egeland,Psychologically Unavailable American Journal of Diseases of Children, Caregiving. September 1976, 941.947. 103. NatiOnal Center for Clinical Want Programs. 131. Freiberg,Infant Mental Health. Infants Can'tWait. Washington, D.C., 1986. 132. Lyons-Ruth, K., Botern, S., & Giunebaum, H. U. 104. Ibid. "Reaching the Hardo-Reach: Serving Isolated and 105. Freiberg,Infant Mental Health. Depressed Motherswith Wants in the Conununity." In 106. Castle, M. "Focus on Prevention in the First 60 Colder & Musick (Eds.),Intervention with Months."Zero to Three,September 1987, 8,(1). Psychiatriailly Disabled Parents and Their Young 107. Raney & BtYasit, "Preventing and Treating Mental Children.San Francisco: Josseyaau, 1981. Retardation". 133. tamer & Halpem, "Lay Home Visiting Programs". 108. Erickson & Egeland,Psychologically Unavailable 134. Kempe, "Preventing Child Abuse". Caregiving. 135. Musidc & Stott,Handbook of Early Intervention. 109. National Center for ainic.al Infant Programs,Infants 136. Freiberg,Infant Mental Heald. Can't Wait. 137. Utbain & Duke,Parent Outreach Project. 110. National Center for ainical Infant Programs,Infants 138. Freiberg,Infant Mental Health. Can't Wait,p. 6. 139. Larson, C. P. "Efficacy of Prenatal and Postpartum 111. Brunquell, D., Cricluce, L, & Egeland, B. "Maternal Home Visits on Child Health and Development." Perionality and Attitude in Disturbances of Child- Pediatrics,1980, 66, 191-197. Rearing."Journal of Orthopsychiatry,1981, 51, 680- 140. Ibid. 691. 141. Committee for Fasnanic Development,Children in 112.. Garbarino es aL,Children and Families. Need. 113. Gatbarino, J. "Social Support Networks: Prescription 142. Lamer & Halpem, "Lay Home Visiting Programs". for the Helping Profeuiau." In J. Whittaker & J. 143. Ibid. Garbarino (Eds.),Social Swat Network: Informal 144. Gray, J., & Kaplan. B. "The Lay Health Visitor Helping in the Human Services.New York: Aldine Program: An 18-Month Flperiment." In C. Kempe & Publishing Company, 1983. R. Helfer (Eds.),The Battered Child (3rd Ed.).Chicago: 114. Ga'barino et al.,Children and Families. University of Chicago Press, 1980. E., & Weiss, IL "Family Support Systems: An 145. Erickson, M. F.Project STEEP. A Description. Ecological Approach to Child Development" In R. University of Minnesota, 1987. Rapoport (Ed.),Children, Youth, and Families: The 146. Dean, J. G. et aL "Health Visitors Role in Prediction of ActionRessarch Relationship.Cambridge, Ma.: Early Childhood Injuries and Failure to Thrive."Child Cambridge University Press, 1985. Abuse and Neglect,1978, 2, 1-17. 116. Bronfenbrener, U., & Weiss, H. "Beyond Policies 147. Kempe, "Preventing Child Abuse". Without People: An Ecological Perspective on Child and 148. Gray & Kaplan,The Battered Child. Family Policy." In E. Zigler, S. Kagan, & E. Kingman 149. Lyons-Ruth, Botein & thunebacm, "Reaching thc I larcbto. (Eds.),Children, Familia, and Government: Reach". Perspectives on American Social Policy.Cambridge, 150. Stott a al., "Severely Disturbed Mother". Ma.: Harvard University Press, 1983, p. 405. 151. Erickson,Project STEEP. 117. Whittaker, "Mutual Helping". 152. Olds, D. "Case Studies of Factors Interfering with Nurse 118. Garbarino et aL,Social Swat Networks. Hasse Visitors' Promotion of Positive Caregiving 119. Whittaker, "Mittel Helping". Methods in High-Risk Families."Early Child 120. Whittaker, "Mutual Helping". Dewlopnent and Care,1984. 121. Garbarino et aL,Children and Families. 153. Larson, "Prenatal and Postpartum Home Visits". 122. Collins, A., & Pancaut, D.Natural Helping Networks. 154. Lyons-Ruth, Botein & thunebaum, "Reaching thc Harco- Wesippott. D.C.: Nuked Association of Social Reach". Wodceri, 1976 155. Stott et al., "Severely Disturbed Mother". 123. Whittaker, "Mutual Helping". 156. Dean et. al., "Health Visitors Role". 121. Musick, J. S., & Stott, F. M. Chapter in preparation. 157. Gray & Kaplan, "Lay Health Visitor Program". To appear in S. Meisel, & J. Shonkoff (Eds.),Handbook 158. Lamer & Halpem, "Lay Horne Visiting Programs". of Early Intervention.Cambridge: Cambridge 159. Gray Z; Kaplan, "Lay Health Visitor Program". University Press, in preparation. 160. Musick & Stott,Handbook of Early Intervention. 125. Whittaker, "Mutual Helping". 161. Ibid. 126. National Center for Clinical Want Programs.Keeping 162. Lamer & Halpem, "Lay Home Visiting Programs". Track: Tracking Systems for High Risk Infants and 163. Kaplan,Working with Multiproblem Families. Young Children.Washington, D.C. 1984, p. 4. 164. Gatborino et al.,Children anfl 165. Brown,Child, Family, Neighborhood. 68 i WAY TO GROW

tix

67 166. Ibid. 167. Garbarino et al., Social Support Networks. 168. Whittaker, "Mutual Helping". 169. Kaplan, Working with Multiproblem Families. 170. Whittaker, "Mutual Helping". 171. Satir, V. Peoplemaking. Pilo Alto, Ca.: Science and Behavior Books, 1972. 172. Garbarino et al., Children and Families. 173. Egeland, B., Jacobvitz, D., & Papatola, K. Intergenerational Continuity of Abuse. Paper presented at Conference on Child Abuse and Neglect, York, Maine, May 20-23, 1984. 174. Lyons -Ruth, Botein, & Grunebaum, "Reaching the Hard- to-Reach". 175. Egeland, B., Breitenbucher, M., & Rosenberg, D. "Prospective Study of the Significance of Life Stress in the Etiology of Child Abuse." Journal of Consulting and Clinical Psychology, 1980, 48, 195-205. 176. Ibid. 177. Lyons-Ruth, Botein, & Grunebaum, "Reaching the Hard- to-Reach". 178. Egeland & Erickson, Psychologically Unavailable Caregiving. 179. Fraiberg, Infant Mental Health. 180. Halpern, CommunityBased Prenatal Care Outreach Programs. 181. Musick & Stott, Handbook of Early Intervention, p. 7. 182. Kaplan, Working with t. ultiproblem Families.

CHAPTER 4

1. Swanson, K., Minneapolis Health Department. Personal Communication, August 28, 1987. 2. City of Minneapolis, Planning Department. State of the City 1987. In preparation.

CHAPTER 6

1. Committee for Economic Development. Children in Need: Investment Strategies for the Educationally Disadvantaged. New York, 1987, p 4. 2. GAO. Prenatal Care: Medicaid Recipients and Uninsured Women Obtain Inssg7cient Care. (GAO/HRD- .1 87-137). Washington, D.C.: United States General Accounting Office, September 1987, p. 5. 3. Opportunities for Success: CostEffective Programs for Children. A Staff Report or the Select Committee on Children, Youth, and Families, U.S. House of Representatives. Washington, DC.: U.S. Government Priuting Office, August 1985. 4. Harris, LB. Address to the National Governors' Association Committee on Human Resources Conference on "Focus on the First 60 Months," February 6, 1986. 5. Committee for Economic Development, Children In Need, pp. 3-4.

69