Utilizing System Dynamics and Community Based Participatory Research to assist in the development of an Early Childhood Intervention Program

In 2011, an urban, Midwestern hospital system decided to develop a community health intervention program.  Its flagship hospital is near low-income populations with significant health disparities.  Community members/organizations advised that an early childhood intervention would be most effective.  Growing scientific evidence shows critical periods of brain development occur during pregnancy and years following.  Rather than duplicate services, we sought to combine existing, proven program in a systematic way to better serve clients. 

 In 2012, we engaged a local University in discussions of program structure.  Group model building (GMB) is a participatory method for engaging stakeholders to understand system dynamics from a feedback perspective, using structured group exercises to develop models to identify/understand the behavior of systems. GMB has been cited by the IOM as an innovative approach to develop integrated community prevention frameworks.

 The first project phase involved five GMB workshops with providers/other professionals. These focused on understanding how existing providers currently functioned--exploring, and eventually designing a “braided program” building upon strengths of individual programs, meant to ensure engagement prenatally through age eight. The second phase contained three GMB workshops with community members to understand resources to raise a child and identify meaningful services. The workshops resulted in a causal map highlighting complex interactions of various social determinants of family/child wellbeing, and concrete ideas to ensure targeted activities by the proposed program were meaningful.

 Along with input from stakeholders/community members, the core concepts identified through GMB were mapped to programmatic goals/objectives to measure program fidelity/impact, and informed program design/evaluation efforts.