Innovation Brief: Mobilizing to Solve a Crisis For Long-Term Impact

Pierce County, Washington

In 2017, Pierce County, Washington faced the highest demand for foster care placement in the entire state—higher even than King County (home to Seattle), which has twice the population of Pierce County. The rate of entry into foster care in Pierce County in 2016 was 4.81 children per 1,000 children, compared with the statewide average of 3.75 children per 1,000 children. Of the 1,000 children under age 18 who entered the foster care system in the county, 25% were babies in their first year of life. Furthermore, data showed that Pierce County had higher infant mortality and maternal mortality rates than the state average, and only 43% of eligible children in Pierce County were receiving early intervention services. 

The foster care placement crisis prompted an inter-agency mobilization by county and state officials who obtained $250,000 in initial, one-time funding in the 2018 state legislative session for a pilot program. 

The pilot program’s focus is on children prenatal to age five with a specific emphasis on children under age three. Program administrators collected data for three critical zip code areas in Pierce County where women and children faced the highest risk. Using the Help Me Grow model as a starting point, Pierce County is building and scaling a custom system for educating and connecting families to existing community services. While Pierce County initiated their pilot program as a strategy to reduce dependency filings and prevent child abuse for children birth to three in three specific zip codes, it serves as part of a broader strategy to improve birth outcomes, promote healthy child development, and build a strong, comprehensive early childhood system for all children and families.
 

Pierce County’s 2018 pilot program seeks to identify already-existing prenatal and early childhood services in the county and plan for a central access website for residents to access these resources. While the foster care crisis shaped the primary goal of the project, to reduce out-of-home placements and dependency filings in the county for children 0-5, stakeholders quickly recognized the opportunity to address additional countywide goals, including improving birth outcomes and strengthening families to promote healthy child development. 

 

Infant and Child Crisis Indicators in Washington State compared to Pierce County, 2017

Indicator Washington State Pierce County
Infant mortality rate per 1,000 births 4.8 5.4
% women receiving early and adequate prenatal care 80.5% 76.9%
% children ready for kindergarten 50.7% 47.7%

Source: “Data Summary Report: Community Data on Children Prenatal through Age 5 in Pierce County, October 2018,” Help Me Grow, Pierce County, WA.

 

Rates of Poverty and Low Birth Weight in Washington State and three Zip Codes in Pierce County 2017

Location Poverty Rate Low Birth Weight Rate
WA State 12.7% 6.37%
98408 (Tacoma, Fern Hill)  16.3% 7.13%
9844 (Parkland)  22.0% 7.52%
98499 (Lakewood, Springbrook)  24.5% 8.07%

Source: “Data Summary Report: Community Data on Children Prenatal through Age 5 in Pierce County, October 2018,” Help Me Grow, Pierce County, WA.

 

While child welfare systems are designed to protect minors from violence and neglect in their primary homes, intervention often occurs only after problems have reached a critical level. Studies have demonstrated evidence-based, voluntary home visiting programs can offer a return on investment of $3.00-$5.70 for every public dollar spent. 

In Pierce County in 2017, the foster care caseload became so severe that Judge Kitty-Ann van Doorninck reached out to State Representative Laurie Jinkins and County Council Representative Derek Young for help. Key officials from the Tacoma-Pierce County Health Department were also invited to participate, as was the Attorney General’s Office and the State Department of Social & Health Services. The group quickly realized that the county had many existing resources that could be used by young families, but there was a lack of coordination among those services and a general lack of knowledge about them. 

One of the original participants in the exploratory meeting was Susan Barbeau, director of First 5 Fundamentals, a nonprofit organization that works to mobilize and inspire the community to achieve its child and family-centered goals. It was Barbeau who suggested Pierce County use the Help Me Grow model to identify and gather existing services into a single access point. 

“We had already done some groundwork around the 0-3 age group in a previous project,” Barbeau said, “so when the opportunity came with the Pierce County leadership, we were able to connect the dots and say, ‘there’s a path to this.’” 

The national Help Me Grow movement was started by Dr. Paul Dworkin in 1997 in Hartford, Connecticut, and exists in 28 states today. The system focuses on promoting the optimal healthy development of young children by providing outreach to families, communities, and providers through a centralized access point, and then linking children and their families to existing community-based services. Because it connects existing nonprofits and services, it can be an inexpensive way for communities to support improved outcomes for young children. Help Me Grow is meant to be used as a systems-level intervention. By emphasizing the use of data to enhance advocacy efforts, the model can have a catalytic effect in a community. 

According to Kate Ginn, director of Pierce County’s pilot project, Help Me Grow was a feasible solution because it would not require extensive funding. “We felt like as a county we had a lot of resources, so we first needed to make sure existing services were being fully utilized through a central access point. We also wanted to identify what we still needed to advocate for.” 

In 2010, Washington State started its first Help Me Grow initiative through a statewide central access point. Pierce County tapped into this infrastructure and saw the need to identify more local services to create their own targeted access point for families. By using the Help Me Grow model to implement a local centralized access point, the county can remain connected to the statewide system while still tailoring the model to the county’s unique problems and solutions. 
 

 

The Pierce County 2018 pilot project used the initial $250,000 from the state legislature to hire a local director—Kate Ginn at First 5 Fundamentals—who worked together with community leaders to create a plan of action. Ginn identified and gathered representatives from over 100 local community organizations, parents, service providers, and multiple government agencies already working in the areas of early support and intervention. Following the Help Me Grow model, Ginn established four “Action Teams,” which met monthly (and continue to meet monthly) starting in August 2018. Each team was charged with a specific task during the pilot period:

  • Creating a Centralized Access Point just for Pierce County—a call center and/or website—that could link families to various support services, government programs, health care providers, etc.
  • Establishing a Family and Community Outreach team to solicit parent and provider feedback to help disseminate child development information to families.
  • Providing Data Collection and Analysis using population data for Pierce County to determine the greatest areas of need and to provide ongoing data collection.
  • Promoting Medical Provider Outreach to identify and link health providers and services to each other and help eliminate inefficiencies in the system.

Ginn noted that the county has wide disparities between neighborhoods and among racial and ethnic groups, so county leaders decided they would need to create a highly-flexible, culturally-responsive model. “We learned during the planning period that we needed to ensure that families have choices. Our system needs to be flexible so it can connect families to what they need rather than what we want them to have,” Ginn said. 

To determine those needs, Ginn and the Action Teams conducted surveys and interviews among families in the county during 2018 with the goal of identifying all possible support services, gaps in those services, and elements that would be needed for a well-designed central access point for the county. Caregivers and parents across Pierce County were invited to participate. The online survey was distributed to families through community service providers, the Help Me Grow Pierce County website, and through parent Facebook groups. A total of 91 survey responses were received. Additionally, 21 qualitative interviews were conducted, targeting participants with previous child welfare experience. (Full survey methodology and results are found in the “Parent Feedback Summary.”)

Results showed the greatest difficulty for Pierce County families was finding affordable, quality child care and housing. Parents also expressed a desire to learn better parenting skills, perhaps by receiving home visits from a medical professional for both health purposes as well as parenting advice. In addition, several issues related to accessing resources surfaced in the survey results. For example, many respondents were unable to get to the places where services were provided due to limited transportation, funds, and securing child care. Many were simply not aware of existing services. 

The survey results supported the Pierce County Action Teams’ desire to expand the Help Me Grow model by including voluntary home visiting services for families with infants. Results indicated that 66% of families were very enthusiastic about receiving home visits. There were already several breastfeeding assistance organizations operating in the area, and the state had an existing nurse home visiting program for eligible families, but Pierce County is hoping to broaden and expand eligibility for those programs. Kate Ginn explains, “We’re trying different levels of care, depending on family needs. Our focus on pregnancy and prenatal care is pretty unique for a Help Me Grow system.”

 

 

In addition to reducing out-of-home placements and dependency filings, preventing child abuse, and improving birth outcomes, Pierce County hopes that implementing Help Me Grow will also improve the sustainability of early childhood systems. One concern expressed by providers during the planning meetings was how to stretch limited resources. Ginn explained that they have tried to address those concerns by using the Help Me Grow model to improve efficiencies and connect families to resources already there. In the future, the county hopes to identify service gaps and plan for additional resources to address those gaps.

According to team participant and registered nurse Evelyn Patrick, the Action Teams were very focused on the end goal of reducing the need for foster care, but they recognized the work should start prenatally. The Help Me Grow national model centers around population-level intervention beginning at birth, but Patrick advocated starting support during pregnancy to include breastfeeding education and identify other needs for expectant mothers. This goal was added onto Pierce County’s program and was approved by the state legislature in 2019. 

In addition, in early 2019, county leaders were able to secure $1.25 million in state funding for a two-year expansion of the county’s Help Me Grow project to support healthy development and strengthen service coordination in Pierce County, including $595,000 to extend home visiting. Kate Ginn says the money will be used partly to hire a family support worker housed in the target zip code areas to conduct home visits, and she hopes to eventually have more visiting professionals on the payroll. Ultimately, the project was designed to inform Pierce County’s plans to scale this new system from three zip codes to county-wide. 
 

Pierce County council member Derek Young worked extensively with state legislators to pass the funding bill for the local Help Me Grow project. He encountered some barriers along the way, particularly with the home visiting portion of the bill, where privacy and government overreach concerns arose.

“Children are a sensitive subject for a lot of people,” Young said. “You have to be much more careful with your language when talking to the legislature about young children. You have to be much more precise because people are much more emotional about this as a subject area. I think if you explain it well, most people want investments in early childhood.”

Another barrier to obtaining public funding for early childhood systems is that the return on investment for an early childhood project is realized long-term. While there is a strong body of evidence and academic literature to support investing early, it could be many years before a community can fully describe the impact. “This is one of the most long-term government investments in children and families I can imagine,” Young said. “We really won’t know how this turns out for a number of years. Those results are going to be where we actually see the benefits. For me, this is a commitment that my successors will have to carry out for me, and that’s not a usual thing in government.”

Susan Barbeau of First 5 FUNdamentals also has advice for other communities looking to learn from the Pierce County model. “Engage with your nonprofits and business communities from the very beginning.” Pierce County cast a wide net when they were planning this project and that made a big difference in community involvement.

Evelyn Patrick reports that the most helpful thing about the planning process was the new coordination established between different services and agencies. “We have a lot of programs—doula programs, breastfeeding organizations, nurse visits,” Patrick said, “but sometimes funds dry up or they close down or they don’t provide the specific service a family is looking for. There needs to be better communication and collaboration between agencies and services so we are not referring people to agencies that have closed and we are not double-booking services. Better communication means we are really helping people. Everyone wants to save the world, but it takes a lot of work and people have got to work together.”

Pierce County leaders are optimistic that the project will continue now that the two-year project has been funded by the state. Nurse Patrick is optimistic that the project will help lawmakers realize the importance of early childhood services. “We know that birth to three are the most important years, and yet there’s very little focus on that timespan, so whatever we need to do to change that, we have to keep trying. We have to keep helping people become aware that those three years of life are critical. And maybe we have to keep coming back, but it’s good that we’re having this conversation now. I think there’s reason to be hopeful.”
 

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