Extant service delivery structures may be strengthened to improve odds that vulnerable children and their families thrive in challenging environments. The presenters will discuss how the CHILD Tool provides a framework to assess and improve the overall quality and mental health climate of early care and education programs. Integrating the CHILD seamlessly into early childhood mental health consultation (ECMHC) will be discussed as an example for improving child outcomes.

The New York State Office of Children and Family Services (O.C.F.S.) regulates all child care in New York State and is the agency accountable for implementing the state’s strategy to comply with the federal Child Care and Development Block Grant Act of 2014 (C.C.D.B.G.). As part of the federal block grant, New York State has an annual budget of $1.1 billion, a significant portion of which is earmarked specifically for improving the quality of child care for infants and toddlers. As part of a movement to address quality improvement through an evidence-based and equity informed lens, O.C.F.S. has partnered with the Fund for Early Learning (FUEL) to reform the state’s child-care system.FUEL has recommended that the state pilot a high-intensity, low-cost model of infant/early childhood mental health consultation (I.E.M.H.C. - presented in this session), which is pioneered by the Yale Zigler Center. I.E.C.M.H.C. is a strengths-based intervention implemented within a collaborative relationship between a credentialed mental health consultant and child-care providers. This intervention is paired with the Infant/Toddler Climate of Healthy Interactions for Learning and Development (IT-CHILD) assessment tool. Robin Hood recommended the Yale Zigler model to policymakers as the best solution primarily because it produces important trajectory-changing child outcomes that are known to build a pathway to greater mobility away from poverty. The data generated from this collaborative project will be the only data that O.C.F.S. will use to determine how C.C.D.B.G. expenditures for mental health consultation and quality improvement will be made from 2022 onward. At scale, this project has the potential to provide an equitable opportunity for optimal early brain development for nearly 90,000 infants and toddlers living in poverty statewide.

New York City Health + Hospitals (H+H) is the largest public health-care system in the United States. It provides essential inpatient outpatient and home-based services to more than one million New Yorkers every year in more than 70 locations across the city’s five boroughs. At this scale, H+H offers an unparalleled opportunity to interact with at least 75,000 infants and toddlers living in poverty. The partnership with Robin Hood's Fund for Early Learning represents H+H’s first effort to address the developmental needs of infants and toddlers by adding supports for parenting skills. The model it has developed represents a bold approach to enhance typical physical health services with a multi-pronged effort that integrates three evidence-based developmental programs known to improve early skills in infants and toddlers while also reengineering key clinical and financial systems to better support families with more seamless care and generate the revenue needed to sustain the innovative model over time with public funds.

NYC Health + Hospitals lacks consistent multi-generational, family centered care coordination and integration for high-risk children aged 0-3 across its system. Through the new 3-2-1 IMPACT! model (discussed in this session), in collaboration with FUEL and New York City Opportunity (a mayoral agency), the team will reform the entire hospital system (spanning over 70 facilities) and establish and improve integrated, two generational (2Gen) care, with the immediate aim to sustain the program through increased revenue capture—and when successful, expand to reach an estimated total of 132,600 unique caregivers (mothers) and children annually. In this discussion, we will discuss how the partnership with FUEL has allowed for innovative thinking in a public system, and gained interest from numerous city agencies to support the city's public health safety net in ways that have never communicated an interest before.