The first steps toward advancing a prenatal-to-age-three agenda in your state begin with defining a clear vision for children and families, followed by strategically developing an effective leadership team to drive the work to achieve it. These two steps will inform each other, almost in tandem. Initial convenings and discussions to start the visioning process will begin with relevant stakeholders and naturally broaden as the group clearly defines the vision, realizing which representatives are essential to seeing the agenda through.

Considering how to approach this work from a systems perspective is critical to avoiding the creation or deepening of silos and gaps among the many resources, programs, and services that prenatal-to-age-three systems require. The prenatal-to-age-three period is one in which children and families may engage with multiple services, yet there is not one central system that serves them during this time, in comparison to the elementary school system. The health system is one common denominator serving children and families, but they are served through a wide range of programs and agencies such as maternal and child health, public health, clinic- and hospital-based services, well child and family practice services. This missing single point of entry for families is why states need to work from a systems perspective to develop and implement plans that address the needs of families during this critical time in their child’s early development. Grounded in a clear, shared vision, your roadmap can pave the way for ensuring all families have the support they need to give their infants and toddlers a strong start in life.

A leadership team—a representative group of stakeholders in the state—must play a lead role in informing the development of policies and keeping close watch over the implementation of those policies to ensure that they are carried out in service of the vision. In order to be both authentic and effective, the team must be developed thoughtfully with deep consideration of representation. That means bringing to the table influential changemakers and empowering individuals who offer new, valuable insight and perspective from their perches, but who may not already be positioned to play a leadership role in these conversations. 

In identifying a leadership structure to guide this work, consider leveraging existing public-private stakeholder bodies that are engaged in birth-to-five systems work in your state (such as Governors' Cabinets, Early Learning Councils or Advisory Committees and Title V Advisory bodies). This approach may help to reduce duplicative efforts and position the leadership team to leverage existing initiatives and convenings. If you determine that an existing body may also serve as the leadership team, next assess whether it is currently comprised of stakeholders critical to achieving the vision and is representative of the community (this includes members from parents to state administrators).

Stakeholders may include: 

• Elected officials, policymakers, and those with the ability to champion a prenatal-to-three agenda to drive policy change and sustain resources. Also consider governor’s office staff and state gubernatorially appointed bodies (such as Early Learning Councils, Early Intervention Councils).
• Representatives across service sectors including, but not limited to, child care and early education, health (including behavioral health and pediatric health care providers), child welfare, K-12 education, post-secondary education, workforce development, housing, advocacy, and philanthropy.
  • State agencies such as public health, education and early learning, Head Start collaboration office, human services, mental health, child welfare, Medicaid/SCHIP, maternal and child health, nutrition, workforce development, early care and family support (child care, CCDBG administrator, home visiting, parent education programs)
  • Statewide and regional nonprofits/community-based organizations, administering federal, state and local funding and programs (Early Head Start/Head Start, Child Care, Home Visiting, Pre-K, quality supports such as QRIS, training entities)
• Business leaders who understand that investments in high-quality child care provide a return on investment through better social, education, and health outcomes, while communities ultimately benefit from a productive workforce, stronger economy and avoid more expensive and less effective interventions later in life.
• Regional or local representation reflective of the state context (large urban or suburban areas, rural regions), inclusive of key grassroots organizations or community leaders who are trusted champions in their communities and can represent the diverse interests and backgrounds of the populations (e.g., racial, ethnic, religious, socioeconomic).
• Grassroots organizations, faith leaders, and community leaders that are trusted champions in the community and represent the diverse interests and backgrounds (e.g. racial, ethnic, tribal, religious, socioeconomic) of the population, and can garner public support for your agenda.
• Families who can speak to the diverse needs of parents, caretakers, and families and can serve as ambassadors who can facilitate effective, sustainable family engagement.
• Philanthropic organizations that have the platform and are positioned to raise awareness, elevate prenatal-to-three issues before the public, and, when possible, direct financial resources to the issues.

After you have developed consensus around your vision and assembled a leadership team, it is important to establish expectations for the group’s role, and how it will work together and arrive at decisions. This step may include defining what the entity is: a subcommittee of an existing structure, a partnership, a collaboration, a coalition, a steering or leadership committee. That decision may be influenced by who is participating in your team. For example, limitations may come from participation by certain types of organizations, such as state government entities. 

An additional facet of working together is establishing expectations of participation such as: sharing resources, commitment of time by participants, level of decision-making authority expected of participants. As a group, these expectations need to be discussed and finalized, along with the ground rules for the process and decision-making that will occur during the work. Each participant will assess their responsibilities to the group and how they are able to support the goal of the state alongside their individual organization vision and objectives.

Locating, collecting, and analyzing data is essential to generating buy-in among decision makers, identifying disparities and inequities in access to services for families and communities, and providing evidence to support continuous improvement and increased access to programs. Data is necessary as a baseline of understanding the experience of infants and toddlers in your state and for planning strategies that will advance the vision and goals established as part of this process.

When strategically collected, data can help uncover risk factors known to have a negative impact on child outcomes, such as the prevalence of poverty and homelessness or the rate of child abuse and neglect. Disparities—gaps in access and participation in services, unequal treatment, adverse health conditions, and early exposures to risks—can have serious and life-long consequences for children. 

Before collecting new data, determine which state entities have already conducted their own prenatal-to-three needs assessment, which is frequently a requirement of federal funding initiatives. For example, the administering entity for the Title V Maternal and Child Health Services Block Grant completes a statewide, comprehensive needs assessment every five years, which directly ties to the maternal and child health services delivered in the state. The state entity administering the Maternal, Infant and Early Childhood Home Visiting grant is also required to complete a statewide needs assessment. There are many other examples of state-level needs assessment requirements, when considering a cross-system approach to planning for prenatal-to-three (Part C Early Intervention, workforce and employment supports, subsidy and public assistance such as Child Care and Development Block Grant and TANF).

States must review and map existing data to facilitate a discussion around the gaps in data and where or how the data can be secured. The mapping process should consider the needs of the population, the needs of the vision and goals for prenatal-to-age-three, and the assets within the state and communities. Community-level data sources and needs must also be considered in relation to the state planning process. The gap analysis process should not only be focused on understanding needs in general but also understanding the variance in needs across the state.  

The CDC offers a list of many national data resources for states and links to reporting resources for using data. You can find their resources here. 

In addition, the Washington State Department of Early Learning created a birth-to-three System Design Framework to assess their programs. Use this helpful guide as a jumping off point for your own work. 

Funding is a critical asset to understand as part of the state vision. The funding streams available for children and families from prenatal-to-age-three are diverse and often siloed in states based on the state-level entity they are administered through and the type of local organizations that deliver on the services. States must begin to understand the asset that is this diverse funding pool by mapping it, understanding which agencies—both federal and state—hold the funds and which programs they are administering with these funds. 

Because there are many different funding sources for this period, it is important that included in this mapping is a tracking of the target population for the funding and the capacity of the funding. Many states find that two to three dozen different funding streams and initiatives for the prenatal-to-three period are actually reaching only a very small population of babies, as a result of the intention and capacity of the funding (e.g., serve only Medicaid eligible women). 

It is also important to understand if the current initiatives are reaching all, or nearly all, of those individuals the funding/service is intended for. For instance, does the Medicaid-only service reach all eligible families? What percentage does it reach? What is the reason for the gap between who could be served and who is served? This gap may not be due to lack of program capacity but due to difficulty finding and enrolling eligible families. As part of the process to map funding and understand reach, state leaders need to be analyzing for these variables and considering what response should be included in their plan to address covered populations going unserved. As you map funding, consider the questions below in "Questions to Ask."

In addition to determining state needs, data can help you identify assets, such as the capacity of home visiting programs and the supply of high-quality and affordable early care and education options. When mapping assets, go beyond surveying the strengths of organizations and state agencies, clearly-defined organizations (or just those on your leadership team), and dig deeper to identify the assets of your state and the communities and regions within the state. Gather information about: 

• Parent groups, teams, or coalitions focused on children prenatal-to-age-three (whether or not your state has a statewide system of local collaborations, there will be local iterations of these groups) 
• Existing funding streams
• The physical assets in the state and who controls them

Once you have identified all assets, map them out to determine the relationships between the resources and develop a full picture of existing services and systems. Asset maps are focused on discovering the existing talents, skills, and resources found in the state and should be designed to build connections among residents, institutions, and organizations. 

When mapping state assets, developing a visual that shows where your strengths are located can help you see clearly and think more deeply about any concerns you may have regarding equity, the concentration of resources, and where services do and do not exist.