Early Brain and Child Development:

Supporting Parents and Cultivating Community

Relationships

Name of Presenter
Material developed by the American Academy of Pediatrics

Revised: August 2018

 Objectives
• Interpret your unique role in supporting
EBCD:
– As a champion for early childhood systems
collaboration
– As a key player in supporting parents and
caregivers as individuals and in communities
• Identify resources and strategies for building
strong foundations for lifelong health
 The Case for Rethinking Well Child Care
• Traditional model not meeting families’ needs
• Many missed appointments
• Dissatisfied with content of visits
• Families expect information on child development,
parenting, and physical health
• Need
– New schedule
– New structure
– New content
Schor EL. Rethinking Well-Child Care. Pediatrics. 2004; 114(1):
210-215. doi: 10.1542/peds.114.1.210.
 Is There a Future for Well Child Care?
• Parents are dissatisfied with the
behavioral and developmental
advice they receive
• Does not prevent drivers of the
chronic diseases of childhood
• Does not identify and mediate
the psychosocial and
environmental risk factors for
toxic stress
Coker TR, Chung PJ, Cowgill BO, Chen L, Rodriguez MA. Low-Income Parents’ Views on the
Redesign of Well-Child Care. Pediatrics. 2009;124(1):194-204. doi:10.1542/peds.2008-2608.

Coker TR, Thomas T, Chung PJ. Does Well-Child Care Have a Future in Pediatrics? Pediatrics.
2013; 131: S149-159. doi: 10.1542/peds.2013-0252f.
 Public Health Equivalent
of the Well Child Visit
• Client interactions provide opportunities to
– deliver services
– conduct information-gathering
– Identifying and fostering strengths
– identify additional needs
– make referrals to community partners

Institute of Medicine Committee on Educating Public Health Professionals for the 21st Century; Gebbie K,
Rosenstock L, Hernandez LM, editors. Who Will Keep the Public Healthy? Educating Public Health Professionals
for the 21st Century. Washington, DC: National Academies Press; 2003.
[Link] Accessed July 13, 2018.
 Public Health Equivalent
of the Well Child Visit
Leadership at the local and state level offer opportunities to
– Partner with other systems to assess population health including the
social determinants of health
– Examine and evaluate evidence based policies to determine their
effectiveness in meeting desired outcomes
– Build partnerships with hospitals, non-profit agencies, home visiting
programs, schools, child care, etc.
– Ensure effective laws, regulations, and implementation such as
through law enforcement, social services, court systems, and
legislative advocacy
– research insights and innovations for personal and population health
services
Institute of Medicine Committee on Educating Public Health Professionals for the 21st Century; Gebbie K, Rosenstock
L, Hernandez LM, editors. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st
Century. Washington, DC: National Academies Press; 2003. [Link]
Accessed July 13, 2018.
 Trusted and Effective
Messengers
Top 10 Information
• Pediatricians are most trusted Sources for Moms (2008)
source of information for Pediatricians (58%)

mothers of young children Friends and family (55%)

Evening news (39%)
• Mothers ask physicians about Internet searches (38%)

health issues, nutrition and Physician office (37%)

Web sites (33%)
diet, and parenting. Parenting books (32%)

• Pediatrician advice is more fully Morning TV talk shows (31%)

Newspaper articles (28%)
followed than other sources. Magazine articles (25%)

Bailey, M. (2008, September 18). New survey reveals moms’ media habits. Marketing to Moms Coalition and Current Lifestyle
Marketing. (Non-peer reviewed research report). [Link]
Accessed August 28, 2018)
The role of health information sources in decision-making among Hispanic mothers during their children’s first 1000 days of life
Shaniece Criss, Jennifer A. Woo Baidal, Roberta E. Goldman, Meghan Perkins, Courtney Cunningham, Elsie M. Taveras. Matern Child
Health J. 2015 Nov; 19(11): 2536–2543. doi: 10.1007/s10995-015-1774-2
 The Importance of the Early Childhood
Medical Home
• Unique and comprehensive, unstigmatized
access to early childhood
• Public’s deep respect for pediatricians and
public health professionals as trusted
guardians of child health
• Number of well-child visits from birth to age 5
• 96.7% of children (ages 0-5) have health
insurance coverage (National Health Interview Survey, 2015)
Source: HC1 Health insurance coverage: Percentage of children ages 0-17 by health
insurance coverage. Available from:
[Link] Accessed August 2018
 It’s What Parents Want!
• McCune et al (1984) reported that 81% of parental questions for
pediatricians concerned psychosocial issues
• In their study, parenting issues were parents' predominant concern:
70% of mothers were more worried about some aspect of their
parenting or their child's behavior than they were about their child's
physical health
• Young et al (1998) found 53% of parents wanted more parenting
guidance in 3 of 6 areas (ie. early learning, discipline, toilet training,
sleep, crying, newborn care)
• Garbutt et al (2012) noted top parental concerns included: nutrition,
obesity, exercise; safety and injury prevention; mental health
McCune YD, Richardson MM, Powell JA. Psychosocial health issues in pediatric practices: parents' knowledge and concerns.
Pediatrics. 1985; 24(1): 127. doi: 10.1016/S0002-7138(09)60435-0.
Young, K. T., Davis, K., Schoen, C., Parker, S. (1998). Listening to parents. A national survey of parents with young children .
Archives of Pediatric and Adolescent Medicine, 152(3), 255-62.
Garbutt JM, Leege E, Sterkel R, Gentry S, Wallendorf M,. Strunk RC. What Are Parents’ Worried About? Health Problems And
Health Concerns For Children. Clin Pediatr (Phila). 2012 Sep; 51(9): 840–847. doi: 10.1177/0009922812455093
 What Families Want
from Well-Child Care?
• Focus on Child Development and Behavior
• More information on healthy growth and development
• Pre-visit materials to prepare for the visit
• Seminars
• Workshops
• Technology for information
• Community resources
• Pediatricians recognize the opportunities for change
Radecki L, Olson LM, Frintner MP, Tanner JL, Stein MF. What Do Families Want
From Well-Child Care? Including Parents in the Rethinking Discussion.
Pediatrics. 2009; 124: 858-865. doi: 10.1542/peds.2008-2352.
 Maternal
Mental Health
Promotion
(awareness,
screening,
treatment)
Parental
Early Literacy
Supports and
and Early Care
Education

Medical
Home
Community Financial
Support and
Advocacy
Child/ Literacy, Tax
Credit,
(quality pre-k, Family Education and
child care, home
visiting, social Legal Supports
services)

Routine Community
Screenings Linkages Across
and Systems/
Surveillance Relationship:
Ongoing Care
Including Toxic Management
Stress Team

Shonkoff JP, Garner AS, American Academy of Pediatrics Committee on Psychosocial Aspects of Child and
Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental
and Behavioral Pediatrics. The lifelong effects of early childhood adversity and toxic stress. Pediatrics.
2012;129(1):e232-e246. doi: 10.1542/peds.2011-2663
 Two-Generation Approach

What is 2GEN? Ascend: The Aspen Institute Website. [Link]

generation/what-is-2gen/. Accessed July 17, 2018.
 5 Key Components of
the Two-Generation Approach

What is 2GEN? Ascend: The Aspen Institute Website. [Link]

generation/what-is-2gen/. Accessed July 17, 2018.
 Fatherhood and
the Two-Generation Approach
• Improves prenatal care and reduces premature
delivery
• Supports breastfeeding
• Contributes to language development
• Improves children’s mental health and reduces
behavioral problems
• Enhances cognitive development
• Reduces teen pregnancy and depression
Yogman M, Garfield CF, AAP Committee on Psychosocial Aspects of Child and Family Health. Roles in the Care and Development of
Their Children: The Role of Pediatricians. Pediatrics. 2016; 138(1): e20161128. doi: 10.1542/peds.2016-1128.
 Bright Futures:
Guidelines for Health Supervision for Infants, Children and
Adolescents, 4th Edition
• Child health must be viewed in its broadest context
• Healthy communities support healthy children
• Attention to health promotion activities, environmental
and social determinants of health, and psychosocial
factors
• Promoting lifelong health for families and communities
• Promoting mental health and child
development
• Focus on child and family strengths
• Sets stage for creative models
Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants,
Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
 Bright Futures:
Guidelines for Health Supervision for Infants, Children and Adolescents, 4 th Edition
Adaptation in States & Communities

Examples of state’s adaption of

the Bright Futures: Guidelines for
Health Supervision for Infants,
Children and Adolescents, 4th
Edition:
• use as standard of care
• increase screening
• increase awareness of health
States & Communities. American Academy ofneeds
Pediatrics: Bright Futures Website.
[Link]
Accessed July 17, 2018.
 Promotion Opportunities Within the
Clinical Setting From the Simple . . .
• Encourage families to consider emotional
development prior to visit (questionnaires, DVDs,
newsletters, community events, parent groups,
posters, postcards, etc.)
• Mental health section on your web site (questions,
facts, resources, etc.)
• Referring families to other professionals or community
health resources
• Invite community professionals to come to the
practice to share information about their work
 Promotion in the Waiting Room
• Posters
• Books/pamphlets (low-literacy, multi-lingual)
• DVD (child development or maternal depression
awareness)
• Waiting room questionnaires
• Volunteers to role-model positive
interaction/Group-talks in waiting room
• Parenting groups
• Parent support resources
Promotion in the Clinical Encounter

Relationships as a VITAL SIGN!

 Family-Centered Means:
Values Operational Principles
• Full family focus • Fluidity of approach
• Family led • Transparent
• Respect • Choice
• Strength-based • Responsiveness
• Racial equity and inclusion

Source: W. K. Kellogg Foundation. Family-Centered Coaching: A toolkit to transform practice and empower
families. 2016. [Link]
[Link]. Accessed July 13, 2018.
 Ways to Check in on Relationships
• Use open ended questions as well as screens
• Engage families in using a book with a child
• Have other staff to engage in education
• Connect families with resources (child care,
parenting groups, etc.) on care coordination
• Ensure the mental health of parent and child
are addressed at each visit
Removing the Stigma of Mental Health
• Normalize mental health conversations and
supports
• Find ways to make families feel comfortable
talking about mental health
• Assess a family’s readiness to share and
address mental health needs
• Follow a family’s lead in making
recommendations about mental health
 Encourage Parents and Caregivers of
Young Infants to...
• Talk (sing) to their baby while
they hold, feed or play with him
• Let him look at their face
• Respond to his gestures, faces
and sounds
• Give him colorful objects to look
at, including books and pictures
 Encourage Parents and Caregivers
of Older Infants to...
• Copy her sounds and
expressions
• Play peek-a-boo and patty-cake
• Teach her to wave “bye bye”
and to shake her head “no” and
“yes”
Photo is used with permission from the
personal collection of Pamela High, MD
• Read books together - pointing
to characters, letting her pat
and taste the book
 Encourage Parents of Toddlers to...
• Be encouraging and
supportive, and set
appropriate limits
• Be consistent; establish
routines for meals, naps
and bedtime
• Make time to play daily
My Smart 18 Month Old Baby [Video]. Youtube Website.
[Link] Published February 2, 2008.
Accessed July 17, 2018.
Encourage Parents and Caregivers of
Toddlers to...
• Choose toys that encourage
creativity (blocks, animals, books)
• Listen to and answer her
questions
• Rhyme, sing and listen to music
together
Photo is used with permission from the
• Choose books with humor so you
will want to read them over and
personal collection of Pamela High, MD

overON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, AAP

Yogman M, Garner A, Hutchinson J, et al; AAP COMMITTEE
COUNCIL ON COMMUNICATIONS AND MEDIA. The Power of Play: A Pediatric Role in Enhancing Development in Young
Children. Pediatrics. 2018;142(3):e20182058
 Encourage Parents and Caregivers of
Toddlers to...
• Encourage drawing, building and
creative play
• Introduce simple musical
instruments
• Acknowledge desirable behavior
often (“I like it when you play so
well together” = TIME IN)
Photo is used with permission from the
personal collection of Pamela High, MD – 10 “time-ins” for every time-out!!
Yogman M, Garner A, Hutchinson J, et al; AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, AAP
COUNCIL ON COMMUNICATIONS AND MEDIA. The Power of Play: A Pediatric Role in Enhancing Development in Young
Children. Pediatrics. 2018;142(3):e20182058
 Encourage Parents and Caregivers
of Toddlers to...
• Create ways for your child
to play with other children
and to have out-of-home
social experiences
• Offer simple choices
(Which book should we
read together?) Photo is used with permission from the
personal collection of Pamela High, MD

Yogman M, Garner A, Hutchinson J, et al; AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, AAP COUNCIL
ON COMMUNICATIONS AND MEDIA. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics.
2018;142(3):e20182058
 Encourage Parents and Caregivers of
Children of All Ages to...
• Give lots of warm physical contact and attention
– promotes a sense of security and well-being
• Be aware of their moods
• Read their gestures, faces and sounds
• Respond when they are upset and when they
are happy
 Encourage Parents and Caregivers
of Children of All Ages to...
• Share books together and tell stories daily (bedtime
routines)
• Speak in the language(s) of the home — the most
natural or comfortable language is best
• Avoid TV/Screens under 24 months of age; instead,
spend time playing together
• For children >24 months, limit TV and screen time
to no more than 1 hour of educational
viewing/day; co-view and interact
• Develop a Family Media Use Plan to balance media
Photo is used with permission from the
personal collection of Pamela High, MD and physical activity -
[Link]
ges/[Link]
Council on Communications and Media. Media and Young Minds. Pediatrics. 2016; 138(5):
e20162591. doi: 10.1542/peds.2016-2591.
 Every Day Every Child:
5 Rs of Early Childhood
• ROUTINES – help children know what to expect of us
- what is expected of them
• READING together – daily
• RHYMING, playing and cuddling
• REWARDS for everyday successes – PRAISE is a
powerful reward
• RELATIONSHIPS, reciprocal and
nurturing – foundation of healthy child
High PC, Committee on Early Childhood, Adoption, and Dependent Care,
Council on School Health. School Readiness. Pediatrics. 2008; 121; e1008-
e1015. doi: 10.1542/peds.2008-0079.
Exemplary Programs Supporting Healthy
Child Development – and Many More!
 Reach Out and Read
• Integrated into primary care clinical practice (in 5,800 clinics
today)
• From infancy through age 5, medical providers:
– give child a developmentally-appropriate, culturally sensitive, high-
quality book
– model, coach, and reinforce effective reading techniques with
young children for parents/caregivers and encourage routine
reading with child at home
– help families understand developmental milestones and provide
guidance and affirmation to foster stable relationships with their
child
Why Reach Out and Read. Reach Out and Read Website.
[Link]
essed July 20, 2018.
 Reach Out and Read Research Findings
• Families read together more often and enjoy
reading together
• Children’s language ability improves with increased
exposure to the program
• Children enter kindergarten with:
– larger vocabularies,
– stronger language skills, and
– a 3-6 month developmental edge
Source: Reach Out and Read: The Evidence. Reach Out and Read Website.
[Link] Accessed July 20, 2018.
 Evidence Based Parenting Programs
• Incredible Years
• Family Check Up
• Triple P
• Parent Child Interaction
Therapy (PCIT)
• Circle of Security
• 1-2-3 Magic Parenting Pyramid. The Incredible Years
Website.
[Link]
• Parents as Teachers Accessed July 18, 2018.

Child Welfare Information Gateway. Available online at

[Link] Accessed August 27, 2018
 Core Community Linkages —
It Takes a Village
• Child Care Resource and Referral (CCR&R)
• Early Education and Care Systems
• Women, Infants and Children (WIC)
• Mental Health Supports
• Parenting Groups (fatherhood initiatives)
• Domestic Violence Support
• Breast Feeding Supports
• Early Intervention
Approaches to Community Partnerships
• Awareness and referral
• Sharing materials
• “Promoting”
• Co-location: service and education models
• Contributing
• Project
• Working to achieve a common vision
• Advocacy
 Child Care Resource and Referral Agency
(CCR&R)
Help parents take the guesswork out of choosing care
by providing:
• Referrals to local child care providers
• Information on state licensing requirements
• Information on availability of child care subsidies
• Information regarding quality rating of various child care
options
• CCR&Rs provide guidance by phone, in person, and in other
ways, even online, that are tailored to each family FOR
FREE!
Choosing Quality Child Care. Child Care Aware of America Website.
[Link]
Accessed July 18, 2018.
 You can find your local CCR&R
with a click!
[Link]

CCR&R Search Form. Child Care Aware of America Website.

[Link] Accessed July 16, 2018.
 Benefits of High-Quality Early Education and
Child Care – Early Outcomes
• Educational
–Lower rate of special education and grade retention
–Increased high school completion
–Higher test scores
• Social-Emotional
–Fewer behavior problems
–More self-control
–Improved peer relations
• Child well-being
–Less child maltreatment and neglect
Donoghue EA, AAP Council on Early Childhood. Quality Early Education and Child Care from
Birth to Kindergarten. Pediatrics. 2017; 140: e20171488. doi: 10.1542/peds.2017-1488.
 Early Head Start/Head Start
• Federal programs • Comprehensive approach:
designed to promote whole child and family
school readiness for low- – cognitive, social, and
income children ages 0-5 emotional development
– EHS: for pregnant – screenings and referrals
women and families with to health, nutrition, and
children under age 3 social services
(with strong home-based – family support and
component) family/community
– HS: for children ages 3-5 engagement
and their families, in
preschool
Head Start Programs. center
Head Start ECLKC model
Early Childhood Learning & Knowledge Center
Website. [Link] Updated July
12, 2018. Accessed July 18, 2018.
 Early Head Start Framework

Research to Practice: Program Performance Measures for Head Start Programs Serving Infants and
Toddlers. Office of Planning, Research & Evaluation Website.
[Link]
serving-infants-and. Published April 15, 2006. Accessed July 18, 2018.
 Early Head Start:
Strong Positive Impacts (1996-2010)
• Child outcomes (at 36 months):
– Larger vocabularies
– Greater ability to solve problems and understand basic
concepts
– Higher levels of functioning
– Better outcomes on several aspects of social emotional
development
• Parent outcomes:
– Parents more likely to read to their children daily
– Parents more positive with their child and greater
repertoire of discipline strategies
Early Head Start Research and Evaluation Project (EHSRE) (1996-2010). Office of Planning,
Research, & Evaluation Website.[Link]
start-research-and-evaluation-project-ehsre-1996-2010. Accessed July 18, 2018.
 Home Visiting Programs
• A voluntary service, designed to reach expectant parents,
babies and young children, who face barriers in
supporting their child’s healthy development
• Offers support and information in the home environment
• Increasing recognition of need to coordinate with other
early childhood programs (e.g. Early Head Start)
• MIECHV – federal program for evidence-based home
visiting programs throughout the states, DC and
territories [Link]
initiatives/home-visiting/home-visiting-program-state-fact-
sheets
Home Visiting Program: State Fact Sheets. HRSA Maternal & Child Health Website.
[Link]
program-state-fact-sheets. Updated August, 2017. Accessed July 18, 2018.
 Evidence Supporting
Home Visiting Programs
• High quality programs have positive outcomes for parents and children:
– Improved parenting skills and quality of home environment
– Improved intellectual development
– Enhanced maternal employment and education
– Improved detection and management of postpartum depression
– Improved childhood immunization and breastfeeding rates
• For example, Nurse Family Partnership Home Visiting Model has $5.70
Return on Investment per Tax Dollar Spent (based on 2005 RAND
Corporation analysis)
• As home visiting programs expand, evaluation is increasingly important
to determine which delivery models have greatest impact and savings

Duffee JH, Mendelsohn AL, Kuo AA, et al. Early Childhood Home Visiting. Pediatrics. 2017; 140(3):
e20172150. doi: 10.1542/peds.2017-2150
About Us. Nurse-Family Partnership Website. [Link]
Accessed July 18, 2018.
 EI: Early Intervention Program for
Infants and Toddlers (IDEA Part C)
• A system of services that helps babies and toddlers with
developmental delays or disabilities
• Serve eligible children from birth through 35 months
• Eligible children have an Individualized Family Service Plan
(IFSP) developed by a team of professionals with the family
– Services vary based on individual child’s needs and may include:
assistive technology, audiology or hearing services, medical
services, nutrition services, physical therapy, speech therapy,
psychological services, and/or counseling and training for the family

What is “Early Intervention”? Centers for Disease Control and Prevention Website.
[Link] Accessed August 27, 2018
Positive Impacts of Early Intervention (EI)
• Specialized services and supports
increase the chances young children
will develop to their full potential
• Young children who receive EI are
better prepared for school and later
life
• Family needs are addressed by
providing emotional support and
information to help them promote
their child’s development and
function as their child’s best advocate
Richard C. Adams, Carl Tapia, The Council on Children With Disabilities. Clinical Report: Early Intervention, IDEA Part C Services,
and the Medical Home: Collaboration for Best Practice and Best Outcomes. Pediatrics. 2013;132(4):e1073-e1088.
[Link] Reaffirmed May 2017
 Local Resources/Asset Maps
• Map out the assets in your community
• Contact Head Start and Early Head Start
partners to request community assessment
reports
• National Library of Medicine and the Centers
for Disease Control and Prevention as
resources
• Talk with state and local health departments,
community partners, and families about
resources
• So much to gain
 Your Role in the Community
It is limitless!
• Linkages • Projects
• Advisor • Outreach
• Presenter • Advocacy
• Media
As a health professional, you are well
positioned to serve as an advocate for
parents and caregivers to:
• Help them build a strong foundation for their
child’s lifelong health
• Help them link to community resources to
support their needs
 “There are no perfect parents and, despite
our best efforts, there will be no perfect
children. But by being good enough, parents
and caregivers are building the safe, stable,
and nurturing relationships that meet a young
child’s deficiency needs and release the brake
on the child’s intrinsic drive to develop,
master, and succeed.”
Garner A, Saul R. Thinking Developmentally.
Itasca, IL: American Academy of Pediatrics; 2018:8.
Questions?