National Collaborative for Infants & Toddlers

Bridgeport, CT, is a community facing significant challenges. Although the city is in the same county as some of the highest-earning areas in the country, 99% of Bridgeport’s school-aged children qualify for free or reduced lunch, 63% of the city’s annual births are funded by Medicaid, and less than 20% of 5th grade students are proficient in math.

Recognizing the challenges in Bridgeport and that early supports for infants, toddlers, and their families benefit the entire community, Bridgeport Prospers—a collective impact initiative that aims to achieve positive, measurable and sustainable impact on outcomes for all Bridgeport children and families—is collaborating with partners across sectors to improve outcomes for infants and toddlers by building an ecosystem of supports rather than focusing on single interventions.

This initiative, called Born Healthy and Ready at Three, is aiming for all of the roughly 1,800 babies born in Bridgeport in 2018 to be born healthy and to meet age-appropriate developmental milestones by age three to set the foundations for lifelong success. This multi-year effort, known as the Baby Bundle strategy, is grounded in brain science research that underscores the importance of healthy early brain development and the negative effects that toxic stress can have on infants and toddlers.

Bringing together a large group of diverse national, state, and local partners, the Baby Bundle strategy relies on real-time data, financial flexibility and innovation, strategic planning and communication, workforce professional development, and continuous quality improvement for success.

The Baby Bundle initiative brings together businesses, academic institutions, and non-profit organizations at the national, state, and local levels to design and implement systems of support for infants, toddlers, and their families.

Recognizing early on that Bridgeport has many disparate programs for infants and toddlers but few system-wide supports that make it possible for coordinated, comprehensive care, the Baby Bundle strategy framework was built to provide the tools needed to build a coordinated, systematic approach to supporting pregnant women, infants, toddlers, families, and other primary caregivers.

The Baby Bundle framework focuses on five core strategies:

1. Expanding Care and Support for Parents
Research shows that stressors such as unstable housing and acrimonious family conflict can become toxic to young children when not buffered by caring, present adults. Toxic stress can damage children’s development and mental health. That’s why a major component of the Baby Bundle strategy is to establish universal screenings—using an innovative new mobile app called Sparkler—to identify the need for early interventions. Through the app, parents will also be connected to maternal wellness, child care, early literacy, and universal home visiting programs. Sparkler is designed to improve early learning and developmental outcomes by creating communication and collaboration channels between parents, caregivers, and doctors.

1. Baby Bundle partner organizations working together to implement these programs include:
   1. • Family Connects International, a universal home visiting program, provides nurse home visits, regardless of income or demographic risk, to guide and support parents of newborns.
      • Reach Out and Read works to increase the number of parents reading to their children through primary pediatric care visits.
      • All Our Kin trains family child care providers in the delivery of high-quality, neuroscience-informed early learning experiences and helps informal family care providers successfully complete the licensure process.
      • Boston Basics parenting videos on assessments, coaching, and referral programs are being incorporated into the Sparkler mobile app.

2. Increasing Authentic Neighborhood Engagement and Case Practice for Families Through Innovation and Better Connections

Collaboration and connections among local partners are distinguishing features of this research and place-based initiative. Developing new and innovative community linkages—such as connecting senior citizens to infants in need of care—are meant to foster and support innovation at the neighborhood level and to augment the initiative’s success through an increase in positive relational touches in the lives of young children and their parents.

Additionally, work is proceeding with the National Interoperability Collaborative, a joint initiative created to facilitate data-sharing practices in healthcare, and the Connecticut Department of Social Services to analyze how the case process can be improved to advance better outcomes for individuals and for families as a unit.

3. Bolstering Civic Engagement Through an Army of Advocates and Helpers

This strategy is anchored in the use of the acclaimed documentary Resilience and relies on engaging pediatricians, the faith community, librarians, higher education faculty, and other civic advocates to support children and their primary caregivers.

4. Building a Diversified Investment Portfolio

Core to the Baby Bundle’s construction and launch is establishing connections between existing programs. With new linkages, partners can review resource effectiveness and coordinate to pursue new funding opportunities.

Supplementary funding for the Baby Bundle strategy is being raised through private philanthropy using creative strategies, such as “Baby Scholarships,” and through events like “Brunch for the Babies” to deeply engage with donors in Fairfield County.

In addition, Bridgeport Prospers is working with Connecticut’s Medicaid redesign team to fund parts of the Baby Bundle. Two-thirds of Bridgeport births are covered by Medicaid, strongly suggesting that expanding coverage to Baby Bundle’s preventive interventions could reduce long-term costs to the state. Connecticut’s Medicaid redesign team is responsible for improving care accessibility and controlling costs in the state health care program, but it relies on care coordination and the types of preventive measures proposed by the Baby Bundle initiative.

Additional funding is required to launch or expand supports at the neighborhood and city level, and Bridgeport Prospers is working with the Institute for Child Success, a nonpartisan research and policy organization, Medicaid, and a private resource development consultant to identify new innovative financing solutions.

5. Tracking and Measuring Impact

The initiative is also focusing on collecting and analyzing accurate data to connect infants and toddlers to the right services at the right times and to assess the overall effectiveness of the Baby Bundle strategy. Quantifying outcomes is imperative to sustaining the framework’s many moving parts with new and reallocated funding, especially from private entities in the first three years of the work.

To connect state and local data systems and provide the data necessary for evaluating and facilitating outcomes, Bridgeport Prospers is working with the National Interoperability Collaborative, Connecticut Department of Social Services, Yale New Haven Health, Bridgeport Hospital, St. Vincent’s Medical Center, Connecticut Office for Early Childhood, and other organizations.

The National Interoperability Collaborative is working closely with the Connecticut Department of Social Services and the Baby Bundle team to increase data accuracy and availability. The new data will be used in evaluating the performance of early child development interventions. Technical guidance is also being sought from the National Implementation Research Network (NIRN) to apply its tools and accountability processes.

To drive population-level change, the Baby Bundle approach requires that actions within each of the five core strategies move simultaneously. While each individual strategy is important to the success of the overall initiative, it’s the coordination of all activities together that will ultimately bring about a sustainable ecosystem of supports for infants, toddlers, and their families.

The Baby Bundle initiative was born out of a strong, data-driven foundation. In 2016, Bridgeport Prospers conducted a landscape analysis that identified community challenges and opportunities and assessed the state of early childhood development in Bridgeport. As part of the landscape analysis, Bridgeport Prospers initiated an asset-mapping project to assess resources throughout the community. This project allowed the organization and its partners to build the Baby Bundle strategy with real solutions to meet the community’s needs, including additional activities and supports to take successful programs to-scale and to add new programs that close gaps in services.

For example, the asset mapping project identified that when Bridgeport mothers and infants leave hospital care after birth, mothers are given a packet of information with available services that can help with challenges like maternal depression. The analysis revealed that in most cases, mothers who need help do not reach out proactively and therefore do not receive the care needed. Thanks to the asset-mapping project, Bridgeport Prospers proposed a universal home visiting program to close this gap in care and align expectations with realities on the ground.

The Baby Bundle’s core strategies also benefit from the extensive application of neuroscience on the effects of trauma, toxic stress, and resilience for infants’ and toddlers’ developing brains. Many Bridgeport families struggle with varying types of trauma, which is why Bridgeport’s early childhood interventions, programs, and services are grounded in evidence-based, protective and preventative trauma-sensitive practices along with health-promoting, resilience processes.

Because of Bridgeport’s innovative approach, neighboring communities are becoming interested in Bridgeport’s Baby Bundle strategy. This expanding interest is creating the opportunity to link multiple jurisdictions and stakeholders across Fairfield County for the first time. And because of Medicaid reform, which is coupled within the Baby Bundle strategy, the framework that began in Bridgeport has the potential to be scaled statewide.

Data-based program assessments demonstrate that there isn’t just one intervention that can provide the support that infants, toddlers, and families need for healthy development. To meet the needs of all families, communities must build ecosystems of support. In Bridgeport, creating this system to achieve positive outcomes for infants and toddlers requires implementing all five strategies at once: expanding care and support for parents, increasing authentic neighborhood engagement and case practice, bolstering civic engagement, building a diversified investment portfolio, and tracking and measuring impact.

This framework approach is designed to be implemented over multiple years—a long-game approach with an organic process that involves listening to community members and learning about the assets they would bring to a methodical system.

While some changes will take several years to be implemented, meaningful progress can be made in the short-term without securing new funding. For example, adapting existing community service practices to be trauma-sensitive, especially in communities like Bridgeport that are wrestling with high levels of trauma, is an important step forward that can be accomplished with some labor hours and knowledge of the community’s assets.

Looking forward, the core concepts underlying the Baby Bundle framework are being examined and vetted at various national convenings leading to new partnership opportunities and efforts to refine the design process and speed up implementation. Data, financing, services, and case processing design issues all benefit from this increasingly broad and collaborative knowledge-development process.