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Putting the Pieces Together for Infants and Toddlers: Comprehensive, Coordinated Systems

Putting the Pieces Together

We envision a nation with states and communities that provide comprehensive, coordinated, well-funded systems of high-quality, prenatal-to-age-5 services that foster success in school and life.


America’s future success is directly tied to the healthy development of today’s youngest children. The early experiences of our young children will shape the architecture of their brains in enduring ways and build the foundation—whether strong or weak—for their own development and that of our nation.

To ensure a good start in life, all children need access to high-quality and affordable early learning and development experiences and health care, and their families need to be engaged in their child’s development and have access to supportive services. Programs and services that address these areas are essential, yet they are only as strong as the infrastructure that supports them. To be effective, programs must be organized within cohesive systems that coordinate and align a broad array of services. We envision a nation that supports the healthy development of all children within their states and communities by providing comprehensive, coordinated, well-funded systems of high-quality, prenatal-to-age-5 services that foster success in school and life. Federal and state policymakers can help make this vision a reality so all children will have a good start in life.

Programs and Services for Infants and Toddlers

A model early childhood system includes the following interrelated programs and services for infants and toddlers:

  • Health:
    • Insurance coverage
    • Prenatal care
    • Primary and preventive care, such as well-child visits, oral health care, and a medical home
    • Guidance for parents to support their child’s healthy development
    • Developmental screenings to identify physical and social-emotional status
  • Family leadership and support:
    • Parenting education and home visiting to engage families in promoting their child’s development
    • Economic supports to meet families’ basic needs
    • Work and family policies such as paid family leave
    • Special supports for families experiencing trauma
  • Early learning and development:

    • Quality child care programs in a variety of settings
    • Early Head Start
    • Early intervention for children with special needs

Beyond a simple menu of programs, however, in a comprehensive early childhood system, services must:

  • Reach all children and families as early as possible with needed services and supports;
  • Genuinely include and effectively accommodate children with special needs;
  • Reflect and respect the strengths, needs, values, languages, cultures, and communities of children and families;
  • Ensure stability and continuity of services along a continuum from prenatal into school entry and beyond;
  • Ease access for families and transitions for children;
  • Value parents as decision makers and leaders; and
  • Maximize investment and foster innovation.

Any effective approach to developing services for infants and toddlers must be grounded in a comprehensive vision of the prenatal-to-age-5 system.

The Need for a System

The decisions we make now directly impact our children and our children’s children. If we hope to leave things better for the next generations, we must ensure the healthy early development of all our children. In addition to increasing the availability of high-quality, affordable services for young children, it is essential that we develop the infrastructure that supports them. A comprehensive system is key to ensuring that:

Families with young children can rely on a coherent system of supports to aid their development.

Currently, child care, health care, and other family supports and services are rarely coordinated and are too frequently divided by where families live, how rich or poor they are, and whom they know. For example, a child with delays in development may go to a well-child health care visit but may not be referred to an early intervention program. Or, parents with a child in a child care center may not know that there are parenting education and family support programs to help them handle their child’s behavior issues. If services and supports are made widely available, all children will be more likely to succeed in school and life.

Families can access needed services.

If a system is in place, families will have the necessary information to find appropriate services for their babies and themselves. High-quality programs will be open to all who need them, will be available at convenient locations and times, and will take into account the family’s cultural values. The proven effectiveness of prevention programs will be widely recognized.

Programs are integrated, coordinated, and well-funded.

Programs to serve young children and their families have historically been developed in “patchwork” fashion in response to specific needs. They frequently are underfunded and have separate funding sources, standards and regulations, and governance structures. Then, when a different need arises, the process is repeated. Over time, a labyrinth of discrete programs has developed, with conflicting policies, inconsistent quality and accountability, and uneven investment. In a well-aligned system, programs will be seamlessly integrated and supported by stable and sufficient funding.

A comprehensive array of services is available for infants, toddlers, and their families.

No one intervention can provide the wide range of services needed to ensure that all infants and toddlers develop to their full potential. In addition to individual programs, comprehensive systems of quality services, supportive policies, and coordinating infrastructure must be established. Creating a system to support infants and toddlers has lagged behind improving systems of care for higher priority populations such as adolescents with severe emotional disturbance or adults with chronic illness. However, intentional focus on building systems of services can ensure that our very youngest children thrive and succeed.

Functions of a System

Created by Marilyn Nolt

This graphic depicts the functions of a “system of systems” where health, early learning and development, and family leadership and support service delivery systems contribute to the central outcome of thriving children and families. The functions convey the ongoing, dynamic process of system building; they serve as the “glue” across all service delivery systems.

Only when all these functions and systems are effectively connected can the desired result of thriving children and families be achieved.

Define and coordinate leadership to articulate a shared understanding of roles and joint leadership to make greater progress toward common goals. Leadership refers to the people and structures charged with planning, implementing, and managing early childhood services and programs. The leadership must have sufficient authority to ensure cross-agency collaboration. Leadership is responsible for establishing the guiding vision, mission, principles, outcomes, and benchmarks for how the various systems work together, as well as for coordinating relevant governance structures and policies. Some states are trying to better coordinate governance by: a) combining agencies/divisions into a new state early childhood agency; b) establishing state-level cross-agency children’s cabinets, commissions, or councils to plan, coordinate, and integrate programs and services; c) creating public-private partnerships in which state government partners with private entities to fund early childhood initiatives; and d) establishing local early childhood governance structures.

Finance strategically to develop fiscal policies that move systems toward delivery of services in a comprehensive manner and that provide financial incentives for ongoing quality and system improvement. Strategic financing strategies allow and incentivize braiding and blending of funding streams; leverage federal, state, local, and private dollars across systems; and secure sufficient and sustainable funding to support progress toward common goals. A highly integrated approach would create a single, integrated early childhood budget to unite fiscal and programmatic information across systems.

Enhance and align standards both within and across systems. Standards should be used to integrate services and practices across systems as appropriate. They must be updated regularly to reflect current child and family needs and best practices.

Create and support improvement strategies that drive continuous improvement in quality of services and their delivery. These strategies should connect improvement activities both within and across systems. For example, some states are developing or modifying Tiered Quality Rating and Improvement Systems for child care and early education settings. Approaches to quality improvement should also be designed to meet standards and achieve desired results and outcomes of a comprehensive system for children and families.

Ensure accountability by designing data systems that track progress on outcomes and benchmarks. Regular and ongoing review and use of data can guide continuous improvement and inform planning, policy, and practice. Data collection, reporting, and analysis can be connected across the comprehensive early childhood system to answer critical policy questions.

Recruit and engage stakeholders to build a broad and diverse constituency to support investment in a comprehensive early childhood system. Strategic communications can be used to increase understanding of the requirements and benefits of a comprehensive early childhood system. Families of young children are significant stakeholders and have valuable leadership skills and insights to contribute to systems building (e.g., creating a shared vision, conceptualizing service delivery mechanisms that are accessible to families). Stakeholders, including parents, should be engaged in leading, planning, evaluating, and improving the comprehensive early childhood system.

Policy Recommendations

1. Create a shared systemic vision for supporting our youngest children and their families.

States and our nation as a whole will benefit when we make a collective commitment to build an early childhood system that promotes high-quality services, coordinates programs for infants and toddlers across agencies, strengthens professional development, and simplifies access to services for families. To do this, we need broader public and political support for a systems approach to expanding and improving services.

2. Increase federal and state investments in building a coordinated system of services for infants, toddlers, and their families.

It is important to balance investments across various types of services and system elements and to provide adequate and stable funding. Funding for existing evidence-based programs must be increased and protected. New funding streams should fill identified gaps, be less categorical and more flexible, and include dollars for infrastructure as well as services.

3. Establish collaborative planning and decision-making structures at the federal, state, and local levels to increase coordination across services for young children.

Collaborative structures, such as state Early Childhood Advisory Councils or advisory groups to Race to the Top Early Learning Challenge state grants, are strongest when they involve diverse representation from stakeholders in both the public and private sectors who are interested in infants and toddlers. In some states, the collaborative entities are public-private partnerships, which bring additional resources and promote a focus on accountability and continuous improvement. Connections between federal, state, and community collaborations build capacity, maximize resources, and promote policies that support a shared vision.

4. Develop comprehensive early childhood plans that focus on infants and toddlers, at state and community levels.

When early childhood plans are comprehensive, they address all types of services and system elements and place the necessary emphasis on the unique needs of infants and toddlers. Plans should include action steps that focus on incremental strategies aligned to the overall plan. Plans become “living documents,” allowing states and communities to review and update them regularly to reflect changing needs and priorities.

5. Establish desired outcomes for infants and toddlers, and monitor key indicators associated with these outcomes.

Measures of young children’s health, development, and well-being transcend multiple programs and services. As such, it is critical that cross-agency information systems are developed and maintained to monitor outcomes and provide data for continuous improvement. With ongoing program evaluation, it is possible to demonstrate accountability and effectiveness.

6. Implement a cross-sector early childhood professional development system to support those who care for infants and toddlers.

Since a variety of programs in diverse settings provide services for infants and toddlers, workforce development must cross all service sectors. An integrated professional development system incorporates personnel preparation and training around evidence-based core competencies, articulates into college degrees, includes alternative pathways to credentials, and links higher levels of training to increased compensation.

7. Promote linkages between various programs and services for infants, toddlers, and families.

Bridges can be built between programs that traditionally operate in silos through approaches such as Early Head Start/child care collaborations or the provision of health and mental health consultants to early childhood programs and child development specialists in the child welfare system. Linkages should also be made to help families, particularly those with at risk children, access needed services and supports.

8. Align new programs with existing services rather than creating parallel efforts.

As new initiatives are proposed, it is helpful to assess the potential opportunities and possible consequences so alignment and comprehensiveness are in place from the beginning. When efforts are well integrated, support for one program or element can translate into support for the system at large.

For a list of citations, download the full PDF.

Putting the Pieces Together for Infants and Toddlers_ Comprehensive, Coordinated Systems


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