Whether it is preparing an older sibling for the arrival of a new baby or potty training a toddler, Camille Carlson recognizes that everyone – whether they are aware of it or not – uses Continuous Quality Improvement (CQI) to improve everyday life. CQI is an invaluable reminder of the strength found in taking small, intentional steps. Therefore, it is important to break up the process into achievable goals – and celebrate the milestones along the way!

As Start Early Washington’s Quality Improvement and Innovation Manager, Camille Carlson’s approach to Continuous Quality Improvement (CQI) is instrumental in supporting home visiting services statewide. Through individual and group coaching, Camille guides professionals in the field toward providing the best possible services for children and families using tools to identify and test changes on a small scale. Together with CQI teams and Washington home visiting programs, Camille works to identify changes that result in significant improvements for the home visiting field, families and children, all part of Start Early Washington’s mission to create strong foundations necessary for more fulfilling work that continuously improves supports and resources available to families statewide.

A Beautiful Reminder

Camille uses her expertise to help home visiting programs deliver services relevant to the unique needs of the children and families they support. Her firsthand experience as a parent fuels her desire to improve systems of support for children, their families, and the teams of staff that serve them. Camille’s motivation for this work grew when she was pregnant with her second child. “During my pregnancy, I had the support of home visitors and supervisors at my fingertips. As I listened to home visiting professionals across the state discuss parent coaching and family observations, I started applying their valuable insight to navigate the changing dynamics of my life with two children. This process helped me gain confidence in my parenting skills, and it was a beautiful reminder that family is central to our work. I was overwhelmed by the support that was given to me and the confidence that it brought, which emphasized the importance of sharing such a positive experience with others.”

Connecting Data to Practice

Quality improvement is essential to providing successful home visiting services where staff collaboratively establish goals, reflect and create actionable steps for improvement. By adhering to a CQI process, home visiting programs can build strong relationships with families, make well-planned decisions and increase positive outcomes to achieve better support for children and families.

The ongoing, collaborative process draws on the expertise and experience of home visitors, supervisors, community partners and families. Although data points are a big part of CQI, Start Early Washington works toward cultivating a culture of continuous quality improvement rather than another set of requirements to check off for reports. “Since I’ve been in my role, we have seen an investment in a CQI culture. Teams have grown significantly, and we are beginning to see a sense of buy-in and excitement around the process.”

Camille shared her immense gratitude for the opportunity to work with and coach organizations that provide home visiting services to families across Washington state with the shared goal of creating positive change for the organizations and families that they serve, utilizing a CQI lens.

Home visiting is a voluntary service designed to ensure that families with young children have the supports and resources they want and need to thrive. They aim to strengthen caregiver-child relationships; promote maternal, infant, and early childhood physical, mental, and emotional health; and link families to community resources and services through cross system collaboration.

The Family First Prevention Services Act (FFPSA) presents an opportunity to strengthen prevention efforts like home visiting and to expand them to more families. FFPSA is federal legislation that reorients child welfare towards prevention and seeks to reduce the use of foster care. Since we know the power of home visiting in preventing child welfare involvement, bringing it to scale could be critical in fulfilling Family First’s goal. Many states are centering their Family First prevention plans around voluntary home visiting, and some are creating pathways for families to access these services in their communities, without child welfare involvement.

In a new brief, experts from Start Early and Chapin Hall at the University of Chicago outline ways to scale up home visiting capacity through Family First. The brief explores key opportunities that have been identified as Family First is implemented and provides recommendations to strengthen collaboration between child welfare and home visiting programs at the federal, state, and local levels, including:

• Scale Up Home Visiting for Additional Capacity
• Partner and Collaborate Across Child Welfare & Home Visiting for Collective Impact
• Implement Home Visiting to Model Fidelity
• Orient Philosophies and Policies around Prevention
• Support a Diverse Community-based Workforce that Meets Families’ Needs

Center Family Engagement

At the 2022 National Home Visiting Summit hosted by Start Early, there was a strong emphasis on the connections between home visiting and FFPSA. The focus on Family First at the Summit reflects the interest across the country to further lean into systems partnerships between home visiting and child welfare agencies to create structural conditions that provide access to supports without stigma or blame. In this way, we can acknowledge and address the inequities that harm children and families of color and lead to further disparities and disproportionate representation in the child welfare system. Read the full report.

Learn more about Start Early’s resources and learning opportunities for the home visiting field.

As the program analyst for Start Early Washington, Anna Contreras is always thinking about what works best to support the children and families that participate in Washington’s home visiting programs. She collects and analyzes a mixture of quantitative raw data as well as the often-overlooked qualitative feedback needed to truly improve and enrich the home visiting experience for children and families. This includes collating information gathered from numerous home visiting professionals across the state.

Anna has dedicated her professional career to understanding how relationship-based supports impact lifelong outcomes for young children and their families. She’s particularly interested in families grappling with adversities, such as migrant and seasonal farmworkers, immigrant communities and dual language learners. “My Latinx background not only identifies me but defines me. As a second-generation immigrant, I relate to the challenges of those who are growing and learning from their native culture while also adjusting to new societal norms and navigating American culture.”

Anna’s commitment to improving the home visiting experience and creating more equitable and inclusive systems that recognize and respect diversity begins with her mother. Home visiting has been part of Anna’s life since the day she was born. Anna’s mother received home visiting services in Washington state when she was pregnant with Anna, a support that was not provided for Anna’s siblings. Because of this experience, her mother was better connected to her community’s resources and felt more comfortable talking through the various roadblocks she was experiencing. In addition, her home visitor helped her better understand the services and supports available to her. They were a trusted partner to nurture and support Anna’s healthy development. This was especially important to Anna’s mother because she didn’t have her mom (Anna’s abuela) near at the time.

Recalling her personal experiences and her experience helping her parents navigate data collection and other complex information, Anna finds it essential to create inclusive forms and dashboards for the home visiting support team.

Anna also shared the importance of considering the impact on the person collecting information. “When creating forms, we consider the impact on the staff asking the questions — such as, what does the answer mean for the respondent? How is this information going to be utilized? What are the unintended consequences for the person sharing the information? People must feel comfortable enough to share this information. They also want to ensure that necessary changes will follow and that they are not wasting their time answering another set of questions; it is hard to be vulnerable, especially when you are unsure of what will happen next with the information provided.”

Whether it’s a first-time parent connecting with a home visitor or staff sharing their experiences with each other, trust and respect are vital to collecting meaningful information. Relationship-building is foundational to Start Early Washington’s work and a key ingredient to affecting meaningful change.

“As a first-generation college student, relationship-building was important to me. Feeling seen and heard was fundamental to my growth and development, and therefore I carry that experience in my work today.” Feeling accepted, safe and connected to a community of support helped push Anna past moments of self-doubt and projected her toward future success in her home life, career and beyond.

The Subtle Differences

Data showcasing the subtle differences in home visiting provider experiences and the depth of variation between the family dynamics they support helps inform the resources and learning opportunities needed for the home visiting field as well as the various elements required to support the children and families they partner with. In addition, such data-driven insights are vital to maintaining an inclusive and collaborative decision-making process for system improvements.

Anna primarily works with Start Early Washington’s home visiting team to improve home visiting services and outcomes for children and their families in Washington state. Anna works closely with the home visiting team to assess customized coaching and mentoring offered to home visiting programs. Similarly, she evaluates how Start Early Washington can best support comprehensive learning opportunities, transparent data collection and thoughtful analysis.

For example, surveys are designed to answer questions such as: Does the home visiting field have the professional development opportunities they need to grow their skills? What additional support is needed for home visitors to feel confident in their role? How can Start Early Washington help home visiting professionals achieve individual and programmatic goals? These questions and more help to ultimately measure how we can support positive system changes —such as gains in knowledge, better time management, improved staff retention and the creation of better family engagement protocols.

Qualitative feedback helps Anna understand the story of home visiting in our state, connecting the necessary data points to improve system outcomes and inform policymakers. Data allows us to see how and when priorities shift for programs, and feedback and discussion help us understand what success and challenges look like for home visiting programs and the families they work with. Qualitative feedback from our home visiting team helps uncover trends in discussions, typically hidden among quantitative numbers alone. This data complements ongoing performance monitoring to ensure continuous quality improvement for home visiting professionals statewide.

Anna’s work strengthens home visiting programs by showcasing the power of relationship-based work, reinforcing the deep connections and trust between home visitors and families. Recognizing the unique identities, heritages, cultures and human emotions while celebrating differences and bolstering representation validates and supports an environment of inclusion for the entire home visiting system.

Trust Is Pivotal

While data is critical to support a high-quality system, trust is pivotal to accessing quality information and rich feedback. Some things for home visiting teams to consider when collecting data:

• Use simplified language; the frame of information is important.
• Are questions clear enough to capture the needed information?
• Do all parties understand how the data collected will inform the home visiting system?
• Does the reader understand their rights and role in responding to the questions?

Co-Creative Learning Opportunities for Home Visiting Professionals

Start Early Washington facilitates learning opportunities as well as unstructured co-creative opportunities for home visiting professionals statewide to build knowledge, seek mentorship, connect and decompress with others in the field experiencing similar situations. Together, they work through obstacles and celebrate successes; since 2020, Start Early Washington’s work has reached nearly 8,235 children and families. Our approach to supporting the home visiting field includes mindfulness practices, reflection, sharing experiences and knowledge that builds trust in a strengths-based learning environment.

In my work, I interchangeably use the terms “Hispanic” and “Latinx/e” to refer to individuals whose cultural background originated in Latin American and/or Spanish-speaking countries or are descendants of persons from those countries. I want to acknowledge that Hispanic or Latinx/e individuals in the United States represent diverse countries of origin with unique histories and cultures. Hereafter, I will use “Hispanic” to describe this population.

Over recent decades, the racial-ethnic demographic composition of children in the United States has rapidly shifted, with Hispanic children largely contributing to these changes. Only 9% of U.S. children were Hispanic in 1980; today, over a quarter of children are Hispanic, and by 2050, it is predicted that nearly one in every three children will be Hispanic. This represents a dramatic increase in the number of those who are eligible for early care and education (ECE). In response to this rapidly growing population, new lines of research have emerged to inform and advance practices and policies that support Hispanic children and families’ well-being.

Recent studies consistently demonstrate that participation in high-quality ECE programs is beneficial for Hispanic children’s academic, developmental, and family outcomes; and in some instances, such programs serve as a protective factor in mitigating adversity or negative experiences among Hispanic children and families. As this evidence continues to mount, some researchers have shifted their priorities to focus on linkages between Hispanic children and families’ enrollment in ECE and their well-being in the challenging landscape of the COVID-19 pandemic. The tumultuous nature of the pandemic has corresponded with new studies unpacking hardships experienced by Hispanic children and families; these studies are often grounded in a deficit viewpoint. While researchers are building a much-needed knowledge base, the use of a strengths-based view is essential for uncovering protective factors, like engaging in ECE programs, that may serve as a buffer for Hispanic children and families from the challenges of the pandemic.

In contrast with other ECE research and the mostly bleak narratives circulating in the media about the negative effects of the pandemic on child and family well-being, results from these descriptive analyses of Educare Learning Network data found that Hispanic children and families demonstrated a variety of social-emotional related strengths. Findings and data from this sample may not generalize to other Hispanic children and families given that these children and families are enrolled in Educare—a model Early/Head Start program demonstrating higher than average program quality. However, changing the narrative and highlighting positive findings related to child and family well-being during the pandemic can potentially inform Early/Head Start and other ECE programs’ efforts to effectively support Hispanic children and families. These descriptive findings cannot yet speak to why this sample of young Hispanic children and their families did not demonstrate declines in these indicators of well-being or how child and family well-being will look in the long run; but they can help emphasize the importance of high-quality ECE and contribute further evidence that positive experiences in the early years may provide a buffer to the challenges faced by children and families, including those resulting from the pandemic.

Find information about research and evaluation within the Educare Learning Network at EducareSchools.org.

In this peri-Covid period, it would be fair to ask, “How can we go beyond recruitment and retention given the shortage of home visitors right now?” After all, supervisors in community-based programs have never worked so hard to find and onboard new home visitors who are racially, culturally, and linguistically representative of families served while also trying to retain the ones who remain. For those of us connected to home visiting who are not supervisors, it is time to examine the systemic conditions that fuel pervasive vacancy and turnover, and to consider changes that could make a real difference both now and in the future for local programs.

Supervisors Know What’s Wrong With the Home Visiting Sector at the ‘Front Door’:

Interested candidates don’t meet educational job requirements set at the systems level. Are we turning away candidates with racial, language and community experience in common with the families served because they didn’t have an opportunity to pursue a degree? Perhaps we could make progress in achieving greater cultural alignment in the workforce with the families in home visiting, if we re-weighted personal attributes, life experience, and competencies as ‘proxies’ for job requirements based on economic opportunity.

Salaries are not competitive nor commensurate with the nature of the work. Let’s face it, there are many jobs that require less training, breadth of expertise, and emotional resiliency that pay the same or more. To retain this critical workforce, we need to advocate for higher salaries that match the expertise that home visitors bring to their work with families, nurture existing job benefits (e.g., partnership and support of peers; ongoing on-the-job professional development), and support opportunities for advancement.

Supervisors Also Know What’s Wrong with the Home Visiting Sector at the ‘Back Door’:

Job expectations keep expanding. Constantly expanding and/or changing expectations for breadth of expertise to keep the job they have, and at the same salary, is experienced by some home visitors as an invitation to leave their work with families.

Lack of opportunities for advancement. There is a need for better defined career ladders driven by the goals and aspirations of the workforce. This isn’t new, but we seem stuck in thinking about this as a challenge at the community, program, or agency level and not more broadly at a systems level.

Perhaps we need to expand our thinking about how to expose practitioners to other sectors of the home visiting field: research, training, administration, CQI, policy, etc. Gains could be made especially with a focus on BIPOC practitioners whose perspectives in these leadership and decision-making sectors are largely missing and yet, who are uniquely qualified to represent the perspectives of the minority families served in home visiting.

For those who have found a sense of calling in direct service with families, we have an obligation to improve the conditions that support them to stay doing what they feel called to do. At a systems level, ensuring equal access to high quality professional development that reflects the lived experience in the language of practitioners is a critical component. For those who want their experience with families to be a foundation for something next, we have an obligation to support their exploration of where in the field of home visiting they could be.

Home visitors often don’t have a seat at the table. Too often decisions are made that directly impact the work that home visitors do – without their feedback involved in the process. Engaging and authentically incorporating practitioner voice from the very beginning in decision-making processes brings critical expertise to the table.

Our Challenge to the Field:

We invite you to engage in further exploration of these issues with us and others from across the home visiting field at the upcoming virtual National Home Visiting Summit in March, 2023. The National Home Visiting Summit is a great opportunity to become personally and professionally inspired to explore who is involved and what is happening across the field of home visiting. The Summit emphasizes the importance of attracting, retaining, and advancing BIPOC representation and voice in all sectors of the field. It’s an opportunity to ask yourself what else you could do to open the ‘front door’ to a racially, culturally, and linguistically diverse, next generation of home visitors and to inspire today’s practitioners to find the place where they can make a valued contribution to the field.

The Challenge

Without an established Quality Rating & Improvement System, Mississippi leaders sought a common framework for quality to better ensure positive child outcomes among their diverse early childhood education providers. While researching options, the successful outcomes of Educare Schools caught their eye.

Read Full Case Study

With support from the W.K. Kellogg Foundation, four Mississippi trainers with diverse early childhood experience completed The Essential Practices of Educare’s Train-the-Trainer program and launched a unique, state-wide professional learning model. They hoped to:

• Introduce common quality standards across the state
• Encourage educators from Head Start, public pre-K, and childcare to learn from each other
• Increase positive outcomes for the majority of Mississippi’s youngest learners

“We like that The Essential Practices of Educare is detailed, practical, and easily understood… It makes people more curious about the context in which learning is happening.” – Holly Spivey, Head Start Collaboration Director & Education Policy Advisor in the Office of Governor Tate Reeves

Last month I had the pleasure of co-leading a session at the BUILD 2022 Virtual Conference: Building Systems, Improving Quality, Advancing Equity.

It was a joy to participate en una charla informal, a coffee talk, with my good friend, and colleague Miriam Calderon. We discussed and unpacked the strength and determination required to lift ourselves, our families, and our communities up in the unforgiving world of policy and politics.

BUILD has been a leader in providing spaces and opportunities for Latine professionals and leaders in the early childhood space to come together both informally and formally to talk and hear about what the Latine community wants and needs.

The Latine community is strong. We know that across this country it is Latinos and Latinas who pick, cook and serve our food, clean our houses and hotel rooms, care for our children, elderly and sick and are part of the backbone of the economy in countless ways.

As I joined with other Latine leaders throughout the week at BUILD and listened to their stories, I was stuck that today in 2022, many still talked about “imposter syndrome”, including me. I have had the privilege and opportunity to sit at many tables at the local, state, and national level but I am sure when I opened my mouth to share a recommendation or idea, there was some eye rolling in the room.

At Start Early, we share a commitment to racial equity and have been working diligently to provide individual staff with the support they need and want to grow and contribute to the early childhood field. For my part, I will be leading and providing a space for Latine individuals to participate in a mentoring circle where we will take time to understand our history as a community in the United States, our personal journeys and culture and how systems impact our progress as individuals and a community.

A common theme we explored was that we need mentorship – ongoing mentorship from people that look like us and understand our culture and values. As I have been reflecting on my own journey, it’s clear that each of has a responsibility to support and mentor the next generation of Latine leaders.

My hope is that through mentorship and in our daily work to change systems, Latine professionals and leaders will sit at any table and confidently speak their truth, represent the needs of their children and communities, despite the eye rolls.

The Challenge

At Child Care Associates in Texas, the central office team noticed that, after a period of gains, its CLASS evaluations of childcare and Head Start/Early Head Start providers had plateaued.

System leaders decided it was time to change how they approached outcomes improvement and they made three important decisions:

• Shift ownership of CCA’s education vision from the central office to campus instructional leaders.
• Recommit to using family experience as a critical performance measure.
• Implement The Essential 0-5 Survey across 25 campuses to provide leaders with a unified framework to move program improvement forward.

Read Full Case Study

The Impact: Energized Leaders Re-shaping Daily Practice to Improve Outcomes and Equity

Karin Scott, Chief Performance Officer, outlines four key outcomes the CCA team experiences with their annual Essential Survey implementation:

• Outcome One – Our entire team now uses a common framework to talk about improvement.
  “We transformed campus director meetings to bring people together who are working on common problems of practice – to share out what’s working, lift up people getting better outcomes, and talk about pivots when something doesn’t work.”
• Outcome Two – We are reducing leader & teacher overwhelm by focusing on where they CAN have impact.
  “It can get overwhelming when you’re dealing with deep root causes to early childhood issues, like a national labor shortage or systemic racism. The Essential Survey toolkit’s root cause analysis allows us to dig down to root causes and build strategies to affect the most change with limited resources.”
• Outcome Three – Staff at all levels are making proactive, positive changes in daily practice.
  “The Essential Survey got teams into the practice of reviewing data. They’re taking it into their own hands to make easy, accessible processes for people. They’re rethinking how they use their time.”
• Outcome Four – We have more data to help us drive equity for families of color.
  “There is a huge equity piece to the Essential Survey work. We serve majority families of color and we need to know how they’re feeling about the services they are receiving, as well as how we can improve. This is a great tool to do that.”

Looking Ahead

The Child Care Associates team is committed to implementing The Essential 0-5 Survey annually to sustain a culture that values and supports leaders. “It was important before the pandemic, but now more than ever we need to know how people are feeling,” says Karin Scott. “Our long-term hope is that our staff are supported and feel motivated to do their best work, which in turns leads to better interactions with children and teachers and better outcomes for families.”

Teacher burnout, under enrollment, workforce retention and well-being – we know many programs across the US are struggling with multiple problems of practice. Addressing these problems of practice can be overwhelming. How to build trust with staff? How to encourage collaborative practice? How to embed these solutions into our ways of working?

Decades of study by the University of Chicago and Start Early reveals that program conditions at the organization level are more closely linked to child outcomes than what’s happening in individual classrooms. The Essential 0-5 Survey, developed in partnership by Start Early and the University of Chicago, is a measurement system that provides insight into the strengths and weaknesses of organizational climate for programs.

At this year’s Shared Services Technical Conference, hosted by Opportunities Exchange, Start Early co-presented with Pre-K 4 San Antonio (Pre-K 4 SA) to share the amazing work Larrisa Wilkinson, Director of Professional Learning and Program Innovation, and her team are doing to make impactful changes in their community.

Data & Goal Setting

The Essential 0-5 Survey data elevated two Essentials as areas for improvement in Pre-K 4 SA’s program – Effective leadership and Collaborative teachers. After completing their first root cause analysis, the leadership team came up with a shared goal: to improve their organizational culture of growth and learning by starting the year developing stronger relationships with educators at both the personal and professional level. Using what they learned about their teachers (interests, needs, etc.), the idea of collective problem solving became integral to moving forward with organizational change.

Small Action Steps

The PreK-4 SA leadership team begin to implement 30-day Plan-Do-Study-Act (PDSA) improvement cycles. Initially, they implemented a “getting to know you” tool with teachers. Directors and Assistant Directors started classroom walkthroughs during the first 30 days of the program year. They looked for and celebrated strong teacher practice and positive classroom environments. Both the South and East Centers dedicated time for peer learning communities (PLCs) to reduce staff meetings. At the South Center, they established a Campus Leadership Team and read receipts to improve two-way communication. The East Center, in addition to increased staff collaboration time, added need-to-know information for staff to their newsletters.

Results

When staff were asked directly, the overwhelming response was it was an effective practice:

• Staff felt more ownership in meetings
• Staff felt increased responsibility and accountability towards continuous organizational improvement;
• Staff felt connectedness and agency, which strengthened trust with leadership
• Transparency was key for Pre-K 4 SA leadership to build trust during the PDSA cycles of improvement

Key Takeaway

Start small. You cannot solve every problem in the world at once. Use the Essential 0-5 Survey data and toolkit to build common language, guide your efforts and identify areas that will have the most impact. When staff see even small amounts of progress, they are motivated to keep trying and start to trust that change is possible.

Are you interested in making organizational improvements but are not sure where to start? Contact us to learn more about how Start Early can help focus your efforts to ultimately improve child outcomes.

Today’s early childhood organizations are vocal about their commitment to diversity, equity, inclusion, and belonging (DEIB). As leaders, we vary in the degree to which we responsively identify and change processes that make those commitments visible. Regardless of how long we have been or where we stand in the field of home visiting, we need not look far to find ways to move from intention to impact.

Consider this quick questionnaire:

• Think about the values and cultural backgrounds of families in your program. Is there cultural alignment between the practitioners and the enrolled families?
• Who is responsible for decisions of policy, job qualifications, and practice protocols for home visitors and supervisors in your program? How many of those who are making system and protocol decisions are actively engaged with families on a day-to-day basis?

COVID has prolonged widespread staff vacancies in early childhood settings. Today’s leaders are faced with the simultaneous challenges of hiring new staff and retaining their current workforce. During this season of workforce upheaval, we need to look for ways to cultivate and elevate the voice, experience, and expertise of those currently engaged in direct work with families to increase DEIB in our programs.

Home visitors, by the very nature of their jobs, are uniquely positioned to support caregivers’ goals for themselves and their child. Parents and home visitors co-develop action plans in the context of the family’s composition of members, culture, community, and economic resources. Home visitors partner with parents and caregivers directly to navigate culturally dismissive, disconnected community systems that are not responsive to the family’s identified needs. Practitioners hold expertise in their local resources, provide in-person and virtual support, are on top of trends and interests of families, and have the experience and perspectives of cultural brokers in the community. They honor a caregiver’s unspoken words, “…nothing about me without me…”.

As we prepare for the upcoming virtual National Home Visiting Summit in late March, let’s keep talking with each other and listening to the perspectives and expertise of home visitors. Let’s challenge ourselves to identify strategies that seek to invite, reach, engage, and cultivate the invaluable input of practitioners. When we return to the routines of our work, let’s commit to create and improve platforms for home visitors’ involvement in decisions related to policy, research and practice that directly impact them.

Interested in learning more about Start Early’s resources and learning opportunities for home visitors and supervisors? Check out our Essentials of Home Visiting online professional development experiences or reach out to us directly at professionaldevelopment@startearly.org.