Health Promotion

Beyond the Moon

By: Paul H. Dworkin, MD

Are we too constrained in setting goals for promoting children’s optimal healthy development? Current events suggest that perhaps we should abandon caution and be far more ambitious in our targets. For example, Congress is now poised to approve The 21st Century Cures Act, a major biomedical innovation bill that includes nearly $5 billion in dedicated funding for major research initiatives at the National Institutes of Health (NIH). Funding priorities include the Obama Administration’s Cancer Moonshot, to accelerate cancer research under the determined leadership of Vice President Joe Biden, and the Council for 21st Century Cures focused on innovative cures, treatments, and preventive measures.

Similarly, philanthropic trends also encourage us to expand our thinking beyond initiatives that yield only incremental advances. BuzzFeeds’ Natasha Tiku describes the current trend of Silicon Valley billionaires and, “wealthy young tech donors, who seek a more high-impact, transactional mode of giving.” Numerous publications and presentations, including a keynote address at The Hartford Foundation for Public Giving’s recent annual meeting, highlight the evolution of giving from the notion of charity to strategic philanthropy. In our own experiences with funders, we are impressed by the extent to which foundations and donors, alike, are increasingly seeking to leverage funding from multiple sources to achieve greater scope, scale, and impact.

What are the big ideas that will attract massive funding from increasingly engaged and strategic funders? As a senior pediatrician, I am mindful of the spectacular advances I have witnessed in our treatments of children with debilitating and life-threatening diseases, disorders, and related conditions. For example, in my professional lifetime, the emergence of successful cancer treatments offers remarkable testimony to our scientific capacity and resolve. Notwithstanding the many disorders still deserving of our attention, extraordinary advances in our understanding of early brain development, early child development, and the “biology of adversity” demand that we also focus maximum resources and efforts on the promotion of children’s optimal healthy development. In our advocacy, we speak of such promotion as a critical but often overlooked element of a tripartite systemic approach that also includes prevention and treatment. Should we be successful in advancing our advocacy for a promotion agenda, how might we reply to donors who inquire as to our priorities and needs? I am now emboldened to believe that we must be prepared to think big!

So how might we respond to the opportunity to secure prodigious funding to promote children’s optimal healthy development? I believe that the answer is informed by our experiences in early childhood system building through the work of the Help Me Grow National Center, as well as our efforts to engage all sectors so critical to achieving optimal outcomes for children through our Connecticut Children’s Office for Community Child Health. Our audacious goal is to ensure that all children have access to a comprehensive, integrated, effective system that supports developmental promotion, early detection, and referral and linkage to community-based programs and services. We must bring to scale and impact those evidence-based programs, services, and interventions that strengthen families’ capacity to promote their children’s healthy development.

Examples of such programs, services, and interventions are abundant. Consider, for example, the impact of providing all child health providers with the requisite knowledge, skills, and resources to promote children’s optimal healthy development through such strategies as the incorporation of Reach Out and Read within their practices to promote language and literacy development, or to embed staff such as Healthy Steps Specialists to engage parents in early learning activities to facilitate their children’s healthy growth and development. Training of home visitors in the use of such tools as Ages and Stages learning activities could strengthen the capacity of parents to promote their children’s development. Providing guidance to child health, early care and education, and family support providers on the process of developmental surveillance and screening would ensure the early detection of children with delays and disorders, as well as vulnerable children at increased risk of adverse developmental and behavioral outcomes. A universally-available central portal of entry would facilitate the access of all children and their families to the wide array of developmental and behavioral services, ranging from publicly-funded early intervention services to community-based programs and supports. A coordinated system of enhanced care coordination would ensure the successful referral and linkage of children and their families to culturally appropriate and geographically-accessible programs and services with a high degree of effectiveness, as well as family and provider satisfaction. The capacity to perform cross-sector data collection would identify gaps and capacity issues and inform our advocacy in support of resource development and expansion.

WHAT WILL WE DO? Bring to scale and impact an early childhood comprehensive system that engages all sectors in a collective effort to strengthen families to promote all children’s optimal healthy development through an integrated process of developmental promotion, early detection, referral and linkage to community-based programs and services.

Admittedly, the notion of copious funding for such an audacious undertaking is, at present, merely hypothetical. Ironically, we have the evidence-based tools, efficacious programs, and practical strategies to build such a system, as well as the technical assistance skills to support system building efforts. Furthermore, our experience in building a dynamic and expansive Help Me Grow affiliate network of states and counties demonstrates the utility of such a vehicle for the rapid dissemination of innovations. Bringing such a system to full scale and impact will undoubtedly require millions of dollars-more than likely tens, if not hundreds, of millions.  However, we also know of the extraordinary return on such an investment for society-at-large.

There is no more compelling case for strategic philanthropy than comprehensive system building in support of children’s healthy development. While research and case studies supporting this contention abound, a recent testimonial by George A. Lombardi, the director of the Missouri Department of Corrections, provides poignant evidence. Lombardi is a 41-year veteran of the department, having served previously as the director of the Division of Adult Institutions for 18 years, assistant director of that division for three years, and a warden for seven years. In his generous introduction to my recent presentation at a state-sponsored convening in Jefferson City, he shared his strong belief in the crucial link between early childhood experiences, early child development, and the challenges he confronts on a daily basis in corrections. He poignantly emphasized how building a system in support of children’s healthy development would remarkably lessen the demands on his overburdened system.

HOW WILL WE DO IT? Apply the process of collective impact to engage all sectors to build a robust early childhood system that brings to scale and impact evidence-based programs, services, and interventions that strengthen families’ capacity to promote their children’s healthy development.  Provide technical assistance, training, data collection, advocacy, and support the dissemination of innovations that address critical contemporary issues.

A major investment in system building to promote all children’s optimal healthy development is a strength-based answer to addressing toxic stress, health disparities, and social determinants of health, with profound societal implications for workforce development and even national security. The notion of a moon shot has both literal (e.g., John F. Kennedy’s, “We choose to go to the moon” speech) and figurative (e.g., Cancer Moonshot) appeal. In encouraging our potential donors to make huge investments in promoting children’s healthy development, we dare to go beyond the moon to our “North Star Goal.”

Paul H. Dworkin, MD, is the executive vice president for community child health at Connecticut Children’s, the director of the Connecticut Children’s Office for Community Child Health and the founding director of the Help Me Grow® National Center. Dr. Dworkin is also a professor of pediatrics at UConn School of Medicine.  Learn more »

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