Hawai`i Early Childhood Action Strategy, 2022 Mid-Year Update

June 2022

Hawai`i Early Childhood Action Strategy 2022 Mid-Year Update

ECAS 6-Month Progress Report

Table of Contents ECAS Overview ............................................................................................................................................................................... 3 January to June 2022 in Review ................................................................................................................................................ 4 The Effects Of The Pandemic On Hawai‘i’s Child Care Industry ................................................................................ 4 Pandemic Conditions Created the Perfect Storm for Family Violence ..................................................................... 5 Key ECAS Strategic Efforts and Accomplishments in the First Half of 2022 ............................................................. 6 Sustain & Strengthen Child Care & Early Learning ........................................................................................................6 Prevent Family Violence and Protect Early Childhood Mental Health .....................................................................9 Support Safe Perinatal Care ................................................................................................................................................. 12 Strengthen State and County Policies Supporting Early Childhood ....................................................................... 13 Respond To Demands for Better Data............................................................................................................................... 14 Innovate & Upgrade Evaluation Designs ......................................................................................................................... 15 Opportunities For Expanded ECAS Impact on The Horizon .......................................................................................... 17 Policy Opportunities............................................................................................................................................................... 17 Sector Leadership and System Strengthening ............................................................................................................... 17 Expanded Resource Opportunities .................................................................................................................................... 17 Supporting Implementation of The Early Learning Act ............................................................................................. 17 Creating Innovative Funding & Policy Mechanisms .................................................................................................... 18 Supporting The Development of The ECAS Early Childhood Funders Hui ........................................................... 18 ECAS Policy Efforts, January - June 2022........................................................................................................................... 20 Healthy and Welcomed Births ............................................................................................................................................ 21 Safe, Secure and Nurturing Families ................................................................................................................................ 21 On-track Health and Development ................................................................................................................................... 21 Accessible and Quality Early Care and Learning ........................................................................................................... 21 Key Activities & Targets ............................................................................................................................................................ 23 Activities January-June 2022 & Targets for July-December 2022 .......................................................................... 23 Team Tables ................................................................................................................................................................................ 23

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ECAS 6-Month Progress Report

ECAS Overview Launched within the Governor’s Office through the Executive Office on Early Learning in 2012, The Early Childhood Action Strategy (ECAS) is a statewide governmental and non-governmental collaborative designed to improve the system of care for our youngest children and their families. Action Strategy is now convened by a local nonprofit organization, Collaborative Support Services Inc. Over 150 partners work across sectors to increase the number of young children in Hawai‘i who are born healthy, develop on track, are ready for kindergarten and are proficient learners by third grade.

Vision & Mission Vision: Hawai‘i’s young children are healthy, safe and ready to learn.

Mission: To bring together government and non-governmental organizations to align priorities for children prenatal to age eight and to strengthen and integrate the early childhood system by streamlining services, maximizing resources, and improving programs to support our youngest keiki.

Areas of Focus Our work is organized into six cross-disciplinary focus areas identified through the Executive Office on Early Learning’s 2012 strategic planning process. Teams in the focus areas identify goals, objectives, strategies, and implementation partners to address gaps in the systems of support for young children.

Where possible, focus areas are co-convened by governmental and non-governmental partners.

Four Goals Strategies within ECAS are chosen to support improvement on four key outcomes: 1) 2) 3) 4)

The number of babies born healthy The number of young children developing on-track The number of children ready to learn when they enter kindergarten.

The number of students thriving in 3rd grade.

Theory of Change When babies are born healthy, into safe and nurturing families, they have a much greater chance of developing to their full capacity during early childhood, reaching kindergarten ready to learn, and thriving by third grade. In addition to a safe and nurturing family, young children are more likely to thrive when they have equitable access to high quality programs and services. This is especially true for young children most at-risk. The Action Strategy network works to provide young children with the village they need to thrive.

Healthy & Welcomed Births (HIMHC)*

Safe & Nurturing Families

On-track Health & Development

Equitable Access to Programs & Services

Highquality Early Learning Programs

Successful Early Childhood Transitions

*Hawai‘i Maternal and Infant Health Collaborative

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ECAS 6-Month Progress Report

January to June 2022 in Review It has been more than two years since COVID-19 reached Hawai‘i and the state implemented a widespread lockdown in the interest of protecting public health. By June 8th, 2022, there have been 290,652 known cases of COVID-19 in Hawai‘i, and 1,465 Covid related deaths,1 more than double the number of cases and deaths only 6 months ago. Today, 77.7% of Hawai‘i residents are fully vaccinated against the virus. 2 The pandemic has taken its heaviest toll on low-income communities and communities of color, and it has unmasked deep-seated and enduring inequities in family wellbeing across the state. In Hawai‘i, Native Hawaiian and Pacific Islanders have had the highest rates of COVID-19 infections, followed by Black and Latino Americans.3 In Hawai‘i, records indicate that 39,428 Native Hawaiians and Pacific Islanders have been infected by the Covid-19 virus and 478 NHPI individuals have died from the virus.4 The economic implications of the pandemic, supply-chain issues, and rising prices, leave a growing share of Hawai'i’s families economically vulnerable. As of May 2022, one in five renters (20.2%) are unsure how they will make next month’s rent, one in eight (12.2%) expect to be evicted, and almost one in three (28.8%) have difficulty covering household expenses.5 So far, government assistance has helped to keep conditions from becoming worse. By June, 2022, Hawai‘i residents report that they relied on Supplemental Nutrition Assistance (SNAP), School lunch and breakfast programs, or government rent assistance to make ends meet. 6 National estimates suggest that the American Rescue Plan’s expanded Child Tax Credit are responsible for cutting child poverty by 30%.7

The Effects Of The Pandemic On Hawai‘i’s Child Care Industry In Hawai‘i, as well as across the country, pandemic related closures devastated the child care industry. 8 Before the pandemic, over half of children under 5 in Hawai‘i were in non-parental child care 10 or more hours each week, and the child care industry generated some $300 million in revenue each year. 9 In December 2019, just months before the start of the pandemic, PATCH counted 23,803 seats in centerbased preschools, infant/toddler centers and family childcare for children younger than 5. Due to the pandemic, capacity fell dramatically in all three of these childcare settings.10 Families stopped sending their keiki to childcare, and many childcare centers and homes closed, some permanently.

As the lockdown eased and the economy has reopened, childcare capacity has slowly expanded as well. By March 2022, Hawai'i had 735 providers, with a combined capacity to care for 20,975 children younger than 5 (still 12% below pre-pandemic levels). Additionally, during the pandemic, many childcare workers have been lost to other workforce sectors Meanwhile, providers face increased operating costs due to inflation.

These issues will soon be compounded by the end of pandemic-relief policies and funding (including a return to lower subsidy reimbursement rates, and an end to stabilization grants) that have been helping to subsidize families and childcare providers.

1 Hawaii Covid-19 Case Counts. https://health.hawaii.gov/coronavirusdisease2019 2 Hawaii Covid-19 Vaccine Summary. https://health.hawaii.gov/coronavirusdisease2019 3 Case rate per 100,000 by Race & Ethnicity. NHPI COVID-19 Dashboard. UCLA Center for Health Policy Research.

4 NHPI Covid-19 Dashboard. UCLA Center for Health Policy Research 5 Percent of households not current on their rent or mortgage and/or have no confidence they can pay next month’s rent. Household Pulse Survey, U.S. Census Bureau. https://www.census.gov/data/tables/2022/demo/hhp/hhp45.html 6 Household Spending Table 1. Difficulty Paying Usdual Household Expenses in the last 7 days: Hawaii. (May 8, 2022) 7 The expanded child tax credit briefly slashed child poverty. 2022. NPR. https://www.npr.org/2022/01/27/1075299510/the-expanded-child-tax-credit-briefly-slashed-childpoverty-heres-what-else-it-d. January 27.

8 Learning Policy Institute. 2021. From Rescue to Rebuild: Developing a National ECE System that Works. June 3.

9 CED.org. Child Care in State Economies. 2020 Update.

10 ECAS analysis of PATCH provider survey data. C.f.: https://hawaiiactionstrategy.org/ecas-data-efforts-1/datawalks2022/3/22/child-care-provider-ccp-data

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ECAS 6-Month Progress Report

Pandemic Conditions Created the Perfect Storm for Family Violence Family violence can undermine the health and wellbeing of both parents and children. Preventing violence in the home is a key to healthy early childhood development. Children have the greatest chance to develop to their full capacity when they live in safe, secure, and nurturing homes.

Young children who endure abuse and neglect, or are exposed to intimate partner violence, may experience emotional, behavioral, and cognitive damage that can affect their development, school readiness and longerterm school success. Victims of intimate partner violence have a more difficult time holding jobs, have fewer educational opportunities, earn lower wages, and suffer other consequences such as higher rates of substance abuse, homelessness, and mental health issues.

In 2020 (the most recent data available), 40% of child victims in Hawai‘i were Native Hawaiian or part-Hawaiian, and Native Hawai‘i women experience intimate partner violence at higher rates than non-Hawaiian women, beginning early in their lives. For young women (ages 18-29), rates of IPV are 55% higher for Native Hawaiians than for non-Hawaiians.11 Higher rates of family violence among Native Hawaiians cannot be divorced from oppressive external conditions such as colonialization, denial of self-determination, racialized systems and structures, and economic stress.12 Violence occurs in all types of families, regardless of socio-economic status. At the same time, there is a strong association between economic crises, parental stress and rising rates of child maltreatment.13 Research shows that every percent increase in a county’s unemployment rate brings a measurable increase in reports of child maltreatment.14 In turn, the health concerns, lockdowns, job losses, loss of child care, pressures of remote learning, and financial insecurity brought on by the pandemic likely all elevated levels of stress, tension and anxiety within families, leading to higher rates of family violence.15 Even before the pandemic, 1 in 6 children in Hawai‘i (and almost 1 in 10 children younger than 5) experienced 2 or more Adverse Childhood Experiences (ACEs). 16 Nationwide, the proportion of mental health-related visits to Emergency Departments for children aged 5-11 increased 24% between 2019 and 2020.17 As the pandemic took hold, the number of calls to domestic violence hotlines rose dramatically. The number of helpline calls received by the Honolulu Domestic Violence Action Center increased by 124% between 2019 and 2020. A full year later, in the summer of 2021, the number of calls to the DVAC Helpline remained 88% above pre-pandemic levels.18 We will have comparable figures for 2022 in October.

11 State of Hawaii, Department of Human Services, Databook. December 2020. p. 16. https://humanservices.hawaii.gov/wp-content/ uploads/2021/10/ DHS-Databook-2020FINAL.pdf 12 Office of Hawaiian Affairs. N.d. Issue Brief: Covid-19 and Native Hawaiian Communities: Native Hawaiians Over-Represented in COVID-19 At-Risk Populations. https://19of32x2yl33s8o4xza0gf14-wpengine.netdna-ssl.com/wp-content/ uploads/Issue-Brief.-Covid-19_corrected.pdf 13 Alex R. Piquero, et. al., Impact report: covid-19 and domestic violence trends. February 23, 2021. National commission on covid-19 and criminal justice. https://covid19.counciloncj.org/2021/02/23/impact-report-covid-19-and-domestic-violence-trends 14 Brooks-Gunn, J., Schneider, W., & Waldfogel, J. (2013). The Great Recession and the risk for child maltreatment. Child Abuse & Neglect, 37(10), 721–729. Boyer, B. A., & Halbrook, A. E. (2011). Advocating for children in care in a climate of economic recession: The relationship between poverty and child maltreatment. Northwestern Journal of Law & Social Policy, 6(2), 300–317; Weiner, Dana, L Heaton, M Stiehl, B Chor, K Kim, K Heisler, R Foltz & A Farrell. 2020. COVID-19 and Child Welfare: Using Data to Understand Trends in Maltreatment and Response Issue Brief. Chapin Hall. https://www.chapinhall.org/wp-content/uploads/Covid-and-Child-Welfare-brief.pdf 15 Laura D. Lindberg, et. al. 2020. Early Impacts of the COVID-19 Pandemic: Findings from the 2020 Guttmacher Survey of Reproductive Health Experiences. Guttmacher Institute.

16 National Survey of Children’s Health. 2019-2020 Combined. Indicator 6.13. https://www.childhealthdata.org/browse/survey/results?q=8755&r=13&g=936 17 National Syndromic Surveillance Program, US, January-October 2019 and 2020.

18 Domestic Violence Action Center Helpline call data for July, August & September, 2019, 2020 & 2021, shared with ECAS, December 8, 2021.

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ECAS 6-Month Progress Report

Key ECAS Strategic Efforts and Accomplishments in the First Half of 2022 Early in the pandemic, the ECAS Convener Team identified four strategic priorities for responding to the pandemic. These priorities and guiding framework continue to guide ECAS efforts in 2022 in response to the broad set of challenges to early childhood development, health, safety and learning that both preexisted and were exacerbated by the coronavirus pandemic. In tandem, ECAS network partners took advantage of opportunities to shore up the foundations of - and improve access to - the systems that support young children. These strategic priorities include:

Sustain & Strengthen Child Care & Early Learning Leveraging the power of the ECAS network, funders hui and backbone, the ECAS network has worked to assure that the childcare industry survived the long period of lockdown and its aftermath. Key strategic efforts in 2022 so far include:

Family Child Care Pathways ECAS and partners continue to support Windward Community College (WCC) in their ongoing effort to create an educational pathway that focuses on the business-specific knowledge and skills needed by potential family childcare providers to start and sustain childcare businesses and careers.

The project goals are to: ● ●

Pilot 3 cohorts of 25 potential family childcare providers, to create and refine supportive curriculum for them: and Support creation of at least 10 new Family Child Care providers per cohort

Components of the Pathways project include the development and delivery of business training and specialized curricula for potential providers on opening and operating home-based childcare programs, and the provision of student incentives, such as business/financial tools and funds to acquire materials or make improvements to the childcare areas in their homes.

A Family Child Care Essentials Certificate program has been developed in which participants complete the basic family child care training series offered by PATCH, as well as an 8-part online, on-demand training series, participate in monthly community-of-practice meetings, and have access to one-on-one practicebased coaching sessions with the Program Coordinator.

As of mid-year, 2022: ● ● ●

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There are 5 active participants in Cohort 2, with 3 projected to complete the certificate program in June and 2 planning to roll over to the 3rd cohort, which is scheduled to begin on July 27th.

The certificate format has been adjusted to a 17-week program that alternates between live zoom sessions and on-demand training, to better meet the needs of participants.

Efforts are underway by Windward Community College to provide elective-based credit hours for participation in the FCC Essentials program and to establish an articulation pathway for program participants into a Human Development and Family Services degree program, which, as of June, is newly under development at the College.

Windward Community College is working with funding and support from Kamehameha Schools to provide stipends and incentive grants for program participants. Individuals may receive up to $900 in stipends for participation, and certificate-completion grants of $1,000 to use towards their family childcare business needs.

June, 2022

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ECAS 6-Month Progress Report

Ka ‘Upena Shared Services Model Many childcare providers are overwhelmed by the deluge of administrative needs required to stay in business. Providing centralized, shared services can relieve these administrative challenges and keep existing providers in business, as well as support potential providers with the start-up and early to ongoing stages of business operations.

Ka ‘Upena is a two-year shared-services pilot, with a planned cohort of 15-20 family childcare and small center-based providers. ●

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The pilot utilizes the "Alliance CORE" online data management system and the expertise/mentorship of Colorado’s Early Learning Ventures (ELV), as well as the strategies of Nebraska’s Early Childhood Exchange, to support providers with their enrollment, attendance, billing, and other business needs.

Providers also participate in a structured learning community of other early care and learning providers, in which they can benefit from peer support, training, and technical assistance opportunities.

In 2022, key goals for Ka ‘Upena Shared Services include: ●

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● ●

Transfer of project management responsibilities for Ka ʻUpena to PATCH. This transition creates synergy with PATCH as the Child Care Resource and Referral agency for Hawai‘i allowing them to manage the long-term development of shared services for the benefit of childcare providers in ways similar to other states and municipalities; Expansion to 10 additional family childcare and 5 small center-based providers Monthly learning-community/networking meetings to 1) decrease provider isolation and increase peer-to-peer learning, and 2) facilitate provider success with shared services and improve their business operations through more efficient, less time-consuming administrative practices Exploration of options for continued, sustainable funding Development of national relationships in the Shared Services network to learn what infrastructure, resources and services are relevant to long-term success of Shared Services in Hawai‘i

As of mid-year, 2022: ● ●

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Administration of the project was successfully transferred from ʻAʻaliʻi Alliance to PATCH in February and a Coordinator was hired to oversee project activities There are 16 participants enrolled in Ka ‘Upena, 10 have completed onboarding, 3 are actively onboarding, and 3 are on hold or have temporarily paused their childcare operations. Participants have an average of 16 years of operating experience and currently have an average enrollment of 5 children in their programs.

A survey was administered to participating providers and found the following: ○ The highest areas of interest in receiving help are tax preparation, marketing, and billing ○ Key challenges involve organization and record keeping ○ Additional areas of interest include leadership, coaching, and mentors ○ Providers would like to improve their Child and Adult Care Food Program (CACFP) participation, enrollment, and parent communication Learning Community meetings have been conducted focusing on the following topics: ○ Goal setting – both personal and professional (including goals of utilizing another component of Alliance Core ○ Nutrition for children ○ Self-Care ○ Time Management (how Alliance CORE can help) ○ Activity Ideas

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ECAS 6-Month Progress Report

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PATCH management staff attended the National Shared Services Technical Conference in Austin, TX, in April

Moving into the second half of the year, PATCH’s goal is to continue to encourage providers to utilize more of the extensive Alliance CORE data management system. ELV and PATCH have been working with a few providers on CORE features they haven’t been using and getting them to branch out in their use of the system, helping and encouraging providers to ask for help, do more training, and explore CORE. PATCH also hopes to reduce workload and create efficiencies in providers’ participation in, and their administration of, the CACFP, by setting up automated submission of monthly USDA reports directly from CORE to Food Program management at PATCH.

Words Matter~LENA Words Matter - LENA efforts are designed to strengthen early childhood language & literacy development, promote family attachment, and school readiness, and strengthen FCC and center-based language environments. At the center of the LENA (Language ENvironment Analysis) intervention is a small ‘talk pedometer’ that counts the number of words a young child hears and the number of conversational exchanges between young children and adults. The data collected through the counter is shared with parents and educators to help them recognize and strengthen the language environment in which young children are growing and developing.

LENA programming was completely overhauled during the pandemic so that it could be delivered virtually.

Thanks to the hard work of our implementation partners on Oahu and Maui, and the leadership and coordination of Family Hui Hawai‘i, as of June, 2022, 308 families in Hawai‘i have participated in Words Matter / LENA programs, including: ● ● ● ●

171 in LENA START 35 in LENA Home 100 in LENA GROW 2 in LENA SP

Data collected through LENA’s ‘talk pedometer’ and through parent assessments affirms that families and teachers who complete these programs develop stronger early childhood language and literacy practices, evident in the number of adult words spoken to children, positive gains on measures of child development, stronger parent-child interactions, and increased time reading together.

Developing a Community-Based Kindergarten-Readiness Continuum Initiated in 2021, this initiative is designed to develop a continuum of strong early language and literacy development efforts in communities of greatest need, leading to healthy and safe children who reach kindergarten ready to thrive.

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ECAS 6-Month Progress Report

● So far in 2022, the collaborative has initiated a series of conversations with early learning community members, HIDOE leadership, and key stakeholders to discuss the ways that a community-based early-childhood continuum would help to issues that these leaders have identified concerning early childhood development, kindergarten readiness, and their lasting implications for student success ● The collaborative has also completed a draft proposal for continuum design, development, and implementation. That proposal outlines a 5-year project beginning in 2 communities that will bring together the network of early childhood and family-serving organizations within these communities and public-school leaders to work together toward the bold goal of ensuring that all children reach kindergarten healthy, safe, and ready to thrive. The proposal has generated interest across multiple private sector funders, with Complex Area Supervisors, and with County leadership.

Prevent Family Violence and Protect Early Childhood Mental Health The ECAS network, teams and backbone have focused efforts on initiatives designed to support family safety.

The Aloha at Home: Nurture Daily Campaign Building on the Safe and Nurturing Families Framework developed by Action Strategy’s Team 2 in partnership with the FrameWorks Institute, The Aloha at Home effort has grown to include a portfolio of efforts to support safe, secure, and nurturing families. These efforts include the creation and expansion of the Aloha at Home - Nurture Daily website for families and service providers.

Highlights: ● ●

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In April, the website was migrated and rebranded to Aloha at Home.

In May, Aloha at Home engaged in a joint social media campaign with Ho'oikaika. We populated our social media this month with the social media campaign. No other posts were made except to create the social media and update the images.

In June, we officially submitted the website to Google. This allows for greater detail to the data from Google. However, because it has only been 21 days of indexing, we don't have a lot of data and some stats are only available after 3 months of indexing. Changes to the menu structure and what we index for search engines causes changes in average pages visited.

Social media: ●

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There are signs of an increase in social media engagement in May due to the social media campaign with Ho'oikaika. There is a decrease in engagement in June because the campaign is over, and work is taking place on the website rather than marketing in social media. The team is working to clarify messaging before bringing more visitors to our social media.

We worked with Facebook and Instagram, as that is what most people use. Between the two platforms, there is a slightly larger reach with Instagram. It may be due to the platform's algorithms (what they display to who and when) or messaging formats (images vs videos; kinds of images/videos). It may also be due to which platform users interact more with. Are they only browsing and not clicking on Facebook? Does Instagram seem to have an easier click reach? Where is our target audience?

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ECAS 6-Month Progress Report

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We learned from Ho'oikaika's social media that the audience is mostly women in the age range of being a parent or grandparent. Ho'oikaika is exploring the audience further and will present their findings at a Team 2 meeting. We learned that if we work together with our partners, our reach will grow exponentially. Together we are strong and can offer referrals for services this way.

NEST Hui Texting Platform Nest for Families provides peer parent educators and clinical specialists through a secure text messaging platform to address parenting concerns, provide guidance, & connect families to vital resources. In partnership with Family Hui Hawai‘i, NEST provided another way for families to support each other in the face of physical isolation and heightened worry.

Early in the COVID-19 pandemic, Nest collaborated with Family Hui Hawai‘i, ECAS, and other partners to launch a statewide pilot to engage vulnerable families in text messaging during the first 1,000 days. Funding for the initial pilot concluded in November 2020, but family needs continued to accelerate as the pandemic persisted. Continuing support from the ECAS Funders Hui and other donors allowed Nest to continue to continue as an ongoing resource for families as social distancing and economic impacts lingered into early 2022. Nest committed to continuing services for those identified as our most vulnerable enrollees until graduation at age two. By extending Nest’s pandemic response pilot through spring of 2022, it has also been possible to follow a cohort of pandemicborn infants throughout the first 1,000 days.

Delays in contracting and distributing DOH committed funds delayed completion of evaluation activities and contributed to a cash flow crisis at Nest’s fiscal parent organization, Multiplier. The full Nest team was laid off on 4/8/2022. Nest continues to operate as a volunteer run organization. The program has closed to new enrollment but continues to support 624 enrolled families and respond to messages five days/week.

The Nest team is in discussions with leadership at four Hawai‘i -based non-profit organizations to establish a new home for Nest services.

Key program outcomes Through low-touch and high-frequency contact with families during the challenging early days of parenting, Nest Peer Parent Educators use SMS text messaging to become trusted supporters that parents can call on when difficulties arise. As this peer-to-peer relationship develops, in the background Peer Educators work closely with clinical and leadership staff to address complex individual family needs while also keeping a close eye on emerging trends, making data-driven changes in our overall approach, and sharing back our real time learning with community partners, funders and policy makers.

Demographics ● ●

During the pandemic, NEST served over 500 families, and connected 203 families to additional needed services 56% of participating families are Hawaiian or other Pacific Islanders

Daily support via text messaging ●

The Nest team continued offering interactive text messaging services statewide to 292 families of infants and toddlers (those enrolled in Nest Hui Pilot) with daily access to peer and professional parenting support and referral to community resources.

Outstanding retention and engagement: ● ●

Within this cohort, Nest demonstrated a retention rate of 90.7% for enrolled families.

As of 2/28/22, 90.7% or participants in this cohort either remained active or graduated.

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ECAS 6-Month Progress Report

Referrals to essential services: ● ● ● ●

All 292 parents were screened for community support needs and had ongoing access to support for emerging needs and connection to community resources 265 total referrals were requested, some families received >1 referral 145 families completed at least 1 referral Top referral partners included: Family Hui (86), Ready4K (17), Home Visitation (34), WIC (45), SNAP (40), Medquest (16), fatherhood (including dads enrolled in Ready4K texting) (39)

Measurable impact on breastfeeding rates at 12 months of age: ●

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Statewide only 52% of infants continue breastfeeding at their first birthday. By comparison, 63% of Nest participants in West Hawaiʻi and 60% for Nest participants statewide, continue to breastfeed at 12 months. While much of the population experienced significant barriers to breastfeeding during the pandemic, Nest’s seamless transition to virtual support for breastfeeding showed significant positive impact for families enrolled during the pandemic.

Well-established evidence links breastfeeding to significant secondary outcomes, including strengthened attachment, reduced infections, delayed subsequent pregnancy, and reduced maternal incidents of child abuse and neglect.

Reduced isolation and positive social connection for families: ●

Nest achieved a Net Promoter Score of 100 with graduating families during the Covid-19 pandemic

Noteworthy developments in Nestʻs approach to serving families: ● ● ● ●

Expanded messaging that had previously focused on the first months of life to provide critical child development and physical, dental, and behavioral health support through 24 months of age.

Engaged deeply with the Marshallese community to create culturally and linguistically sound messaging for a particularly vulnerable immigrant community.

Benefited from the guidance of Hawaiian cultural leaders to assure that messaging supports integration of Hawaiian language, culture, and traditions.

Increased behavioral health support and access for participants throughout the first 1,000 days

The Integrated Infant & Early Childhood Behavioral Health Plan Completed in the Spring of 2021, the IECBH Strategic Plan proposes to integrate child and family mental health and trauma-informed care into our health and early care and learning systems throughout Hawai`i.

This integration will create an intentionally aligned child and family-serving system that promotes positive social emotional development, school readiness, and family success. The plan will lead to equitable systems of care that reduce racial and socioeconomic disparities, ultimately ensuring that children succeed in school and in life.

Key implementation steps Several key implementation steps were made to support the IECBH Plan: ● ● ● ●

Karen Shore has joined the team as coordinator to oversee implementation of the plan (with Department of Health/DOH and private foundation support for the first two years) It is anticipated that the position will become a permanent position within DOH after those two years Legislation was passed creating a DOH Trauma-Informed Care Task Force The 2022 Legislative session saw the creation of an Office of Wellness and Resilience that will report directly to the Governor and will have responsibility for aligning statewide efforts to respond to early childhood trauma and its implications more effectively

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ECAS 6-Month Progress Report

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A Financing Sustainability Workgroup with participation from DHS’ Med-QUEST Division was created to maximize funding/resources A vetting process was developed for the Infant and Early Childhood Behavioral Health workforce To date, 90 people have been trained as part of peer learning communities and 39 mental health professionals are in training to gain new expertise in infant mental health

Support Safe Perinatal Care Protecting the health of mothers and babies during the prenatal, inter-partum and postpartum periods is critical to maternal and infant health and well-being, and sexual and reproductive health care has become more difficult to access during the pandemic. 19 In response, ECAS teams, partners and backbone have worked with project teams to fund and scale innovative efforts to reach our most vulnerable communities.

These efforts have included:

Midwifery Integration Home Visitation Program (MI-Home): The MI-Home program is intended to bring perinatal care to high-risk women who are not able to access perinatal services in a traditional office setting. MI-HOME provides these services regardless of insurance status or a patient’s location. Many clients in the program are homeless or housebound and are dealing with complicating medical conditions such as diabetes, mental health concerns and substance use disorders. Referrals into the program come from a broad range of partners, including homeless outreach services, mental health and substance use providers, and Federally Qualified Health Centers (FQHCs).

Efforts to date: ● ● ● ●

MI-Home has provided midwifery services to 311 individuals (including 111 infants); 56 of the adults were unsheltered or were staying in an emergency shelter.

Conducted over 970 midwifery visits 66% of MI-Home’s pregnant clients had a substance use disorder 54 of the mothers with SUD maintained custody of their children by meeting CWS requirements

Since the beginning of 2022, the MI-Home program has been on hold while working to secure an appropriate institutional home and appropriate mechanisms for reimbursement for the costs of providing complex sets of services that span both medical care and the broad set of confounding, related needs.

Key lessons learned: ● ●

Finding a suitable organizational home requires mission alignment as well as agreement on an appropriate scope of services for the program Preliminary attempts to secure insurance reimbursement for coordinated care services are encouraging. Efforts are currently underway to understand how robust and replicable these mechanisms are

19 Laura D. Lindberg, et. al. 2020. Early Impacts of the COVID-19 Pandemic: Findings from the 2020 Guttmacher Survey of Reproductive Health Experiences. Guttmacher Institute.

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ECAS 6-Month Progress Report

Strengthen State and County Policies Supporting Early Childhood Commit to Keiki Modeled after California’s Choose Children Campaign, the Commit to Keiki Initiative has been made possible by significant financial support from the ECAS Funders Hui and national funders. The initiative is an effort to place the wellbeing of young children front and center in Hawai‘i’s electoral politics and public policy.

The initiative has four main goals: 1)

All mayoral, county council, legislative, and gubernatorial candidates incorporate young children and families into their campaign messaging 2) All candidates participate in forums focused on young children and families 3) Winning candidates include commitments to young children and families in their first 100-day priorities and budgets 4) Winning candidates dedicate funds in their county and state budgets to support young children and families The Hawai‘i effort began with a statewide voter poll conducted in the midst of the pandemic that indicated that a substantial majority of voters (80%+) support: ● ● ● ●

Protecting programs that support keiki and ‘ohana from budget cuts Investing in early care and learning Preventing family violence and Supporting children’s mental health

In 2022, ECAS continues to work actively with the offices of Honolulu Mayor Rick Blangiardi and Hawai‘i County Mayor Mitch Roth in order to build strategic agendas, develop new staff positions, and prioritize efforts to support the wellbeing of young children and their families through both ARPA funding decisions. and County funding decisions. County coordinators and points of contact will be convened through ECAS Team 4. ●

●

●

● ●

In a major development, Hawai‘i County has contracted Angela Thomas (ECAS Team 4 Coconvener) as Early Childhood Resource Coordinator and committed $7M in funding to expand and strengthen the child care industry in Hawai‘i County. Additionally, Hawai`i County has committed $5M to support mental health and Angela is hoping to have some of those funds committed to our youngest keiki and their families.

Honolulu County has extended an offer for a Special Assistant for Children and Families, with the goal of turning this position into a Director of Children and Families and add two additional staff members Honolulu County is also standing up a permanent housing project for domestic violence survivors and their keiki and focused a large majority of their Grants-in-Aid on programs and services that support the County’s youngest keiki.

Kaua`i County committed $800,000 to renovating a public space for preschool classrooms and will be engaging in Commit to Keiki efforts Counties meet periodically with Commit to Keiki partners for guidance, data, and research

Under the direction of the Commit to Keiki Steering Committee (established in 2021), public forums have been held with gubernatorial candidates Vicky Cayetano, Kirk Caldwell, Lynn Mariano and Josh Green.

Forums with Heidi Tsuneyoshi, Gary Cordery and Kai Kahele will happen in July. To date, all candidates

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have committed to keiki by participating in zoom-side forums, exploring policy and budget considerations, and including messaging in their campaigns. The Commit to Keiki website is updated regularly to reflect gubernatorial efforts, a social media campaign has been launched, a Steering Committee formed, a policy identification process designed, and key messaging efforts are underway.

Rona Suzuki has joined the Commit to Keiki team as the Lead for Policy and Strategy, Janis Higaki has joined as the Coordination Lead, and Laurie Au has joined as the Community Outreach Lead.

Respond To Demands for Better Data The pandemic has increased the urgency of calls for clear, targeted, and rapid data on family needs, and the reach and effectiveness of strategic efforts. ECAS backbone and teams have responded to the need for better data and information in a range of ways. These have included:

Community Profiles Project Team 4 has initiated an early childhood community profiles project that started with profiles for Maui and Hawai‘i Counties. These profiles are designed to establish an evidence-informed understanding of the current status of key measures of child wellbeing ● The effort will help identify areas of greatest need, establish an evidence base for team strategic decisions, and provide a baseline for evaluating progress and the efficacy of team efforts ● Funding for the project was secured through the ECAS Funders Hui, a contractor was hired, and the project team set to work in December 2021 ● A first round of data on early childhood wellbeing was shared in January 2022 and has been used in strategy and resource allocation decisions at both the county and state levels ● Final profiles for both Maui and Hawai‘i counties - including extensive narrative reports, & tables of key indicators, will be completed by September 1, 2022 ● Working with the ECAS Funders Hui, the community profiles project plans to produce 2 updated profiles each year. Planning for Kauaʻi and Honolulu County profiles is underway, and funding has been secured for the Kauai profile.

ECAS Child Care Industry Dashboard Drawing upon information collected by PATCH and DHS, the ECAS childcare dashboard tracks facility closures, capacity, vacancies, seats lost and industry needs. The dashboard is updated quarterly (and is available here).

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ECAS Early Childhood Data Dashboards The ECAS dashboards, available here, monitor and track how Hawai‘i’s young children are doing in terms of health, safety and learning. These dashboards establish: ● ● ●

Key benchmarks of early childhood wellbeing along the four ECAS goals Longitudinal trend and comparative data Connections between team efforts and desired child and family outcomes

Alignment With Executive Office on Early Learning Data Efforts ECAS has been working closely with EOEL to align data efforts, prevent duplication, agree on best data sources, and ensure that: ●

●

Our indicators and measures are aligned with the State Early Childhood Plan, address key priorities established by the Early Childhood Action Strategy network, and help address key strategic questions (e.g.: what data should be considered in decisions about where to expand early learning capacity?)

ECAS & EOEL dashboards are based on a shared architecture and database, and are being developed in alignment with each other

Innovate & Upgrade Evaluation Designs User Focused Evaluation Design (Sprint #1) ECAS Team 2 completed a user-focused evaluation design sprint focused on the Aloha at Home - Nurture Daily effort, in collaboration with Mark Cabaj of Here to There Consulting. This involved: ●

● ●

Engaging with key user groups to understand the types of data and evidence that they would like to have to assess the utility of the Nurture Daily web platform, and to understand the format and frequency of reports that users would need Helping to develop an iterative framework for evaluating a range of efforts Developing tools to replicate relevant aspects of the user-focused evaluation-design sprint with other teams and projects

ECAS Evaluation and Outcomes Harvesting Continuing to work with Mark Cabaj in 2022, the ECAS backbone has devoted efforts to developing a coherent framework for evaluation with a focus on identifying the ways in which the ECAS network is working to affect systems change. This effort has gathered momentum in 2022 and has been upgraded several times. The objective of this effort is to develop and refine an understanding of how the ECAS network and backbone is engaged in system change efforts and evaluating the effectiveness of these efforts.

Dimensions of Systems Change Specific dimensions of system change that resonated with the ECAS network’s efforts have been identified. ● Navigating the Landscape to respond to shifts in national, state & local political & funding

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ECAS 6-Month Progress Report

● ● ● ●

opportunities, forming key political alliances, responding to emerging issues & external upheavals (e.g.: Covid), & responding to the influx of new information & research findings Shifting Awareness & Culture across the public & among at-risk families about early childhood development, family health & safety, and how best to support them Effectuate Policy, Increase Investment & Improve Alignment to adopt shared priorities, policies & regulations & increase the flow of funds to promising practices Support Niche Innovations to develop, test & as appropriate, replicate, scaling & exporting new programs, models & practices Strengthen Cross-sector Leadership to increase the capacity of leaders & of the organizations & institutions that support families in Hawai‘i.

Key Achievements In addition to clarifying the system-change context in which the ECAS network operates, key achievements include: ● ● ●

● ●

Developing a set of tools to describe & evaluate ECAS network efforts Building an understanding of the broad landscape of activity that, collectively, seeks to address pain points in the systems that support early childhood development Creating a framework for understanding and assessing the ways that many strategic efforts collectively constitute a ‘field of activity’ that may seem uncoordinated and unevenly related, and still function as a collective set of efforts Making tangible the connections between ECAS efforts and their impact & significance, in the context of a complex and evolving landscape In the second half of 2022 & through 2023, we will expand use of these methods and frameworks across ECAS fields of activity and train conveners in their use

SIPSI Evaluation (Sprint #2) Focusing on ECAS’ contribution to important system and policy changes around family safety. The sprint includes: ● ●

Conversations with key stakeholders concerning important system and policy innovations that came about, in part, due to ECAS involvement Exploring evaluation strategies that are a good fit for understanding ECAS efforts, potentially including Impact Mapping, Outcomes Harvesting, and SIPSI (Significant Instances of Policy and Systems Improvement) techniques (with consultation & direction from Mark Cabaj, Here to There Consulting)

June, 2022

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Opportunities For Expanded ECAS Impact on The Horizon The following bullet points summarize potential opportunities for strategic innovation in the second half of 2022 that we anticipate are on the horizon:

Policy Opportunities ● ●

● ●

Across the state, there is growing interest in identifying opportunities to co-locate childcare, family support services and affordable housing We anticipate an urgent need to strengthen reproductive health supports due to the Supreme Court’s recent decision overturning Roe V. Wade and other states’ abortion and access to birth control determinations There is a growing and urgent need across the board for workforce development strategies (childcare/preschool, early intervention, child welfare, home visiting, behavioral health Despite significant ARPA dollars, very few have been made available for family violence prevention/intervention and/or mental health. Need is high

Sector Leadership and System Strengthening ● ●

●

The Executive Office on Early Learning has hired a new Director, adding much needed stability to a key support system for young children Both Hawai'i and Honolulu Counties have hired Early Childhood Resource Coordinators to coordinate and strengthen their systems of support for young children and their families and Kauai has expressed interest in developing a similar position The ELB has hired an Act 46 Coordinator to advance implementation of Pre-Kindergarten legislation

Expanded Resource Opportunities ● ● ● ● ●

The Legislature has dedicated $200M to develop new pre-kindergarten facilities, and hired a coordinator to oversee that effort Hawai`i Children’s Trust Fund has reorganized and is putting out a new round of RFPs Department of Human Services is actively working to get out over $120M in childcare funding The Bezos Foundation intends to stand up Bezos Academy preschools in HI, beginning on Maui The Murray-Kaine Child Care Reconciliation Plan currently under consideration in Washington DC would significantly expand access to childcare with federal funding

Supporting Implementation of The Early Learning Act Act 46 establishes a statutory commitment to providing access to early learning opportunities for all 3 and 4-year-olds in Hawai‘i. Act 46 is one of the few (and likely the single most extensive) State commitment to expand early learning opportunities during the pandemic.

The 2022 Legislative session saw the passage of HB 2000, allocating $200M in resources to expand the number of early learning spaces statewide, which are sorely needed to make the promise of Act 46 a reality ● ●

With our allies, ECAS will continue to support the implementation of Act 46 Key provisions in the Act likely will require careful advocacy and education to best support the intent of offering universal access to quality early learning opportunities ○ Clarifying the specifics of monitoring and evaluating the initiative

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Implementing a meaningful kindergarten entry assessment, ideally one that can be disaggregated to identify communities where more effort would be helpful in supporting kindergarten readiness ○ Ensuring the Act includes a mixed-delivery system, supporting both public and community-based childcare and preschool opportunities ○ Ensuring the Act does not inadvertently jeopardize infant and toddler care HB 2000 authorizing language is extremely limited, leaving space for community groups to provide support to ensure implementation aligns with the intent of the legislation ○

●

Creating Innovative Funding & Policy Mechanisms Pandemic relief efforts have included development of innovative mechanisms for blending and braiding government and nongovernment sector dollars, and for combining state, federal and county funds.

Federal ARPA dollars present tantalizing opportunities for the State and Counties to choose strategies to address the needs of families. Many ECAS network partners have been active in thinking about ways that communities might best apply their ARPA funds to best support the wellbeing of young children & their families.

Extending Emergency Rulings During the pandemic, the Department of Human Services used emergency rulings and federal waivers to expand family income and activity eligibility for childcare subsidies. In a sense, the ‘emergency authorization’ allowed states to look for ways to rush needed resources to families and the providers supporting them. Federal waivers allowed Hawai'i to extend Medicaid coverage to post-partum mothers and infants for 12 months.

In 2022 the Legislature agreed to devote state funds to extend the Medicaid expansion initiated during the pandemic. Fully a third of mothers and newborns (almost 6,000 births a year across Hawai'i) are insured through Medicaid. Advocates across the ECAS network, led by ACOG (the American College of Obstetrics and Gynecology), succeeded in their efforts to encourage the Legislature to pass HB 1600 HD1 SD2 CD1 with a $5.8M allocation, extending the 12-month Medicaid extension. This is a key win: ● ● ● ●

●

Complications associated with pregnancy do not always end when the pregnancy ends – the evidence shows that 60 days of postpartum health care is not enough When they are pregnant, people are highly motivated to address their healthcare problems, and that progress in their health can be disrupted when insurance coverage is lost HB1600 supports equitable access to healthcare by extending the reach of insurance to some of Hawai’i’s most vulnerable communities By extending uninterrupted health care coverage into the postpartum period, pregnant and birthing people can access screening, counseling, and treatment, which will improve the health of the most vulnerable of the families, women, and children of Hawai'i As emergency rulings and federal waivers expire and relief funding wanes over the next 6-18 months, extensive advocacy will be required to mitigate a "cliff" effect for families and service providers and to craft longer-term solutions to access issues

Supporting The Development of The ECAS Early Childhood Funders Hui In 2022, the Early Childhood Funders Hui continues to respond to the urgent need to focus on pandemic relief, recovery and sustainability efforts and, at the same time, to focus energy on opportunities to improve the systems that support young children and their families in Hawai‘i.

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Participants in the Early Childhood Funders Hui include: Aloha United Way, Castle Foundation, Consuelo Foundation, Hau‘oli Mau Loa Foundation, Hawai‘i Community Foundation, Hayashi Foundation, HMSA Foundation, Kamehameha Schools, Lili‘uokalani Trust, Menehune Foundation, Samuel N. and Mary Castle Foundation, The Omidyar Group, the Stupski Foundation, and the Weinberg Foundation.

The Early Childhood Funders Hui is designed to help private foundations align their efforts around the wellbeing of young children and their families. This coordination took on added significance during the pandemic and recovery. Of the eleven proposals that Action Strategy teams have submitted to the funders’ hui, ten have now received full or partial funding and are either in an advance planning or implementation phase.

Through the ECAS Funders Hui, private philanthropic foundations: ● ● ● ● ● ●

Learn about the priorities of their philanthropic peers Discover opportunities to collaborate and share resources Align efforts around common priorities Create opportunities for shared learning around vital and emerging topics Have an opportunity to review ECAS funding-ready projects that have been proposed by the teams and vetted through the funding memo development process Share lessons learned

The Hui has recently embarked on learning/discussing/problem-solving around the complex set of issues related to: Braiding private and public funds Transitioning initiatives that have been incubated via philanthropic dollars to public funding streams The collective effort and generosity of participants in the Early Childhood Funders Hui have proven critical to the private philanthropic response to the COVID-19 crisis. In 2021, Funders Hui partners pooled and disseminated more than $2M to support projects benefiting young children and their families. ● ●

Projects that have recently received funding and funding commitments through the ECAS Funders’ Hui include: ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

MI-Home Midwifery Home Visitation Program Breastfeeding Toolkits and Statewide Coordination Support Words Matter LENA Early Literacy programs Technology Gifting Program Early Care and Learning Shared Services Commit to Keiki Candidate Education Family Child Care Pathways Aloha at Home - Nurture Daily The Integrated Infant Early Childhood Behavioral Health Plan and Consultation models Nest for Families Text Support Contributions to the Child Care Grant Program (Matching state funds to sustain the childcare industry) Developing a community-based early childhood continuum community-level Early Childhood Profiles (Maui & Hawai‘i County near completion, Kauai & Honolulu pending) Aloha at Home Perinatal Substance-use Treatment pilots using Peer-support Models Child Care Live Data modules

June, 2022

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ECAS 6-Month Progress Report

ECAS Policy Efforts, January - June 2022 During the pandemic, the policy landscape in Hawai'i has been characterized by both expansions and contractions of opportunity. In 2020, Governor Ige announced a budget that offered significant hope to working families, but as the pandemic took hold, the session ended with bleak budget projections and vastly diminished expectations. One bright spot in that otherwise bleak landscape was the passage of the Early Learning Act (Act 46), setting Hawai'i on a path to offering childcare and early learning to all 3 and 4-year-olds in the state.

In contrast, the 2021 legislative session began with state agencies braced for devastating budget cuts. Yet massive infusions of federal relief dollars meant that by the end of the session, state agencies - and early childhood advocates - were scrambling to spend billions in federal emergency relief and recovery aid.

Planning for ways to spend those funds became a key policy focus for ECAS this past year.

The 2022 session found the Hawai'i Legislature responding to a $2 Billion budget surplus with expanded income support for working families, expanded health care coverage and social services for low-income families, and a $200 Million commitment to expanding the facilities available for pre-kindergarten. A more complete review of the efforts of the ECAS network to help shape legislative action in support of young children and their families is offered below.

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As in previous years, Early Childhood Action Strategy participated actively in the legislative process during the spring 2022 session, guided by a policy framework developed at the start of the year. The ECAS policy framework outlines those strategic areas that have been prioritized for advancement by the ECAS network.

The framework has been aligned to team and network goals and is intended to guide legislative agendas and policy recommendations for furthering Hawai’i’s progress towards a comprehensive system of care for our keiki and ‘ohana. ECAS policy priorities include:

Healthy and Welcomed Births ● ● ●

Increased access to high-quality and evidence-based sexual and reproductive health services Expanded and improved access to prenatal, inter-partum, and post-partum health services with a focus on meeting the needs of under-served communities and addressing inequities Increased support services that address the mental, emotional, and physical health of infants, parents, and caregivers

Safe, Secure and Nurturing Families ● ● ●

Increased access to family-strengthening programs that focus on parenting, child development, attachment, and early literacy Expansion of programs and policies focused on child abuse and neglect and intimate partner violence prevention/ intervention Improved supports for addressing economic, food, and housing insecurity in families with young children

On-track Health and Development ● ● ●

Support for children’s healthy social-emotional development through early childhood behavioral health services and systems development Improved systems for screening and referral and increased access to early intervention services for children at risk for developmental delays Increased promotion of and support services for early childhood health, wellness, nutrition, and obesity prevention

Accessible and Quality Early Care and Learning ● ● ●

Expanded and stable supply of quality early care and learning programs that includes and values a diversity of settings Increased childcare financial assistance and expansion of publicly funded early care and learning programs Increased compensation and professional development support for the early care and learning workforce

The 2022 session was marked by strong alignment, coordination, and collaboration among early childhood advocates across the ECAS network and benefited from critical groundwork laid in the last several years, heightened awareness of the needs of children and families emerging from the COVID pandemic, and a significant state surplus making resources available for investment.

In many ways, the 2022 session proved to be a game-changer for families with young children. As the session ends, the legislature has adopted measures that will improve the health, safety, development, and early learning of Hawai‘i’s youngest keiki. ECAS salutes the hard work of both the Executive Branch and the Legislature in advancing key measures across all these domains.

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ECAS 6-Month Progress Report

Bills Passed We note the successful passage of the following bills: ● ● ● ● ● ● ● ● ● ● ● ●

Postpartum Medicaid Coverage Extension, $5.8 million appropriation (HB1600) Medicaid adult dental benefits, $8.8 million appropriation (HB1754) Residential programs that allow minor children to remain with their mothers during mental health, drug treatment, etc., $200,000 appropriation (SB2641) Earned Income Tax Credit and living wage bill (HB2510) Children and Families of Incarcerated Individuals, $420,000 appropriation (HB1741 and HB1600) Family Resource Center Pilot Program, $300,000 appropriation (SB3111 and HB1600) Newborn Hearing Screening and Vision and Hearing Screening bills (HB986 & HB987) Establishment of the Office of Wellness and Resilience, $894,528 appropriation with six positions (SB2482) Expansion and improvement of the Child Care Workforce Registry, $80,000 appropriation (SB2700) DHS Child Care Grant Programs bill (SB3110) Expanded funding for preschool facilities, $200 million appropriation (HB2000); and Restoration of funds to the Preschool Open Doors program, increase of $6.96 million to appropriation (HB1600)

Taken together, this set of measures reflects a whole-child and whole-family perspective that is consistent with what we know can ensure that all young children develop to their full capacity and reach school ready to thrive. Making this vision tangible through policy is consistent with Hawai‘i’s commitment to ʻohana as the foundation of strong communities.

June, 2022

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ECAS 6-Month Progress Report

Key Activities & Targets Activities January-June 2022 & Targets for July-December 2022 In the first half of 2022, the six core ECAS teams & backbone: ● ● ● ●

Continued to meet virtually to advance the collective agenda Continued to review and re-prioritize efforts to build an effective response to the needs of families and support systems during both the pandemic and recovery Teams also revisited their work plans in order to best support implementation of Hawai‘i’s Early Childhood State Plan To varying degrees, team conveners are identifying, modifying, and reviewing measures of team progress and related measures of success for young children and their families, including: ○ The dimensions of child and family wellbeing that they hope to improve ○ The availability of measures to help teams track their success in improving those dimensions of wellbeing, and ○ The steps that they believe will best begin to move those measures

The following table reports in depth on the principal activities and achievements of each of Action Strategy’s six teams in the first half of 2022. In addition to activities and achievements, the table includes: ● ●

A preliminary set of measures that each team is using to track Key Progress Indicators and Measures of Impact for their efforts, and Targets that each team has set for their efforts and outcomes for the second half of 2022

Team Tables

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ECAS 6-Month Progress Report

ECAS Team 1 – Healthy & Welcomed Births Hawai‘i Maternal & Infant Health Collaborative (HMIHC) ECAS TEAM 1

THEORY OF CHANGE

CONVENERS

The mission of Team 1/HMIHC is to improve maternal and infant health outcomes, while advancing health equity and reproductive justice, by enhancing systems and supports for Hawai‘i’s families and communities.

Healthy pregnancies and physical, social & emotional development in the first years of life support the health of mothers and newborns, and support the optimal, ontrack development of young children.

● Bliss Kaneshiro (JABSOM) ● JoAnn Farnsworth (Consultant) ● Jennifer Elia (ECAS)

GOALS

KEY MEASURES OF SUCCESS *

In 2022, Team 1/HMIHC will continue to advance their work across 6 strategic areas designed to improve maternal and infant health. Specific activities completed, underway, and to be initiated in 2022 are discussed in detail below.

Team 1 is revisiting their specific metrics in 2022, as part of the team’s strategic planning process. These data will help the team identify communities facing health inequities and provide a baseline for understanding the effectiveness of various interventions. Workgroup goals may include: ● ● ● ● ● ●

Early and accessible prenatal care Equitable contraceptive access Preterm birth rate Maternal and Infant mortality and morbidity Breastfeeding exclusivity and duration rates Decrease rates of perinatal substance use through gender specific prevention and treatment

For more details, visit.: https://hawaiiactionstrategy.org/dashboard-goal-1 *Some teams can track their key measures of success while other teams are still working to define appropriate measures

HEALTHY & WELCOMED BIRTHS STRATEGIES

ACTIVITIES

1) Improve systems of care and support ● Implement a PSUD peer support for perinatal people with substance use demonstration project (Makua Allies) disorder (PSUD) and their infants to increase bonding and successful completion of CWS service plan among perinatal people with SUD ● Train perinatal substance use peer support specialists (PSS) ● Support PSS through reflective supervision in collaboration with EPIC `Ohana and AIMH-HI ● Work with evaluation team to understand how we will know that we are doing what we hope ● Work with CWS, DHS MedQuest & ADAD to secure ongoing support for peer support demonstration project

June, 2022

KEY ACHIEVEMENTS JAN-JUNE 2022

6-MONTH TARGETS JULY-DEC 2022

● Enrolled 11 clients in Makua Allies demonstration project, 5 babies born so far, none placed in foster care ● Continued the process of implementing a demonstration peer support project for substance using perinatal women to improve access to gender supportive treatment for women and to improve reunification rates for women in treatment with infants (0-3) ● Secured additional funding for pilot ($70k from HCF/HCTF for 20222024) ● Connected with new Hawai‘i CARES contractor (AUW 211 and Care Hawai‘i)

● Continue Makua Allies demonstration pilot recruitment and engagement ● Secure Makua Allies project funding for 2023 ● Complete a training curriculum for CARES staff on how to address the needs of perinatal substance using women & conduct initial trainings on that curriculum with initial intake workers

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ECAS 6-Month Progress Report

HEALTHY & WELCOMED BIRTHS STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN-JUNE 2022

● Develop the perinatal referral process with the PATH clinic and Kapiolani OB/GYN department, allowing for direct referrals to PSS – to help reduce trauma if baby is removed as mom completes her treatment ● Training for Hawai‘i CARES staff ● Establish a workgroup that will develop the curriculum ● Meet with the CARES staff to cocreate the curriculum and conduct the training

● Completed draft of PPW chapter of ADAD State Plan

2) Increase access to contraception and promote reproductive life planning

● Conduct One Key Question (OKQ) training through Power to Decide ● Create a sustainability plan for reproductive life planning for Hawai‘i primary care settings ● Investigate and resolve barriers that prevent (same day) access to LARC/contraception of choice in multiple settings ● Assess and make recommendations for insurance confidentiality processes for adolescents and dependents

● OKQ certification training with Power to Decide (via HMHB): 146 participants signed up and 42 completing the training ● Addressed contraception reimbursement issues ● Conducted assessment of adolescent confidentiality processes and policies by insurance companies (“ Confidential and Consequential: Expanding Protections for Confidential Communications for Adolescents in Hawai’i”)

● Start developing sustainability plan for reproductive life planning training for Hawai‘i ● Create/maintain list of different settings that require investigation, determining barriers to LARC/contraception ● Explore adolescent confidentiality strategies/policy options with stakeholders

3) Promote and support breastfeeding

● Engage with community members and insurance providers to enhance reimbursement for lactation support ● Update and disseminate breastfeeding-related resources for families and providers ● Explore next iteration of breastfeeding toolkit

● Launched RWJF-funded project to expanding breastfeeding support to highest need communities: LATCH (Lactation Access Transforming Communities of Hawai‘i) ● Partnering with DOH and HIPHI to plan Breastfeeding Health Equity Grant implementation for 7/2022 to 6/2023 -focus maternity care practices and community PSE (policy, systems, environmental change) ● Supporting integration of BF objectives in PAN Plan meetings w/health plans & stakeholders re: insurance coverage, formula response, contribute lessons learned from toolkit integration in primary care flow to statewide P-3 Planning

● Plan for August Breastfeeding Week activities ● Continue work with DOH and HIPHI to implement Health Equity grant activities ● Conduct focus groups & survey statewide to identify barriers to breastfeeding support

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HEALTHY & WELCOMED BIRTHS STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN-JUNE 2022

4) Improve quality of care and community resources and supports for perinatal people

● Inventory existing community resources and support measures for families after pregnancy and birth complications ● Advise on blood pressure cuff pilot ● (To be developed by new Workgroup)

● Convened new “Maternal Health & ● Collect community resources/support Perinatal Care Workgroup” (first measures lists and processes from meeting June 2022) partner organizations ● Collaborating with Hawai’i’s Perinatal ● Collate and evaluate lists and Quality Collaborative (PQC; birthing processes; identify gaps and hospitals) and Alliance on Innovation opportunities in Maternal Health (AIM) on patient ● Solidify workplan goals for 2022-23 safety bundles and community engagement, focused on reducing preventable maternal mortality and severe morbidity

5) Collect, analyze, and disseminate data to inform the work of the team and its partners, and explore opportunities to reduce infant morbidity and mortality

● Collect and present publicly available maternal and infant health data for Hawai‘i and relevant literature ● Coordinate HMIHC requests for aggregate vital statistics data from DOH

● Data to inform strategic direction was ● Complete strategic plan update with presented at strategic planning performance measures and targets, meeting/ retreat in January 2022 with focus on disparities ● Drafted (in progress) list of ● Explore infant morbidity and performance measures, i.e., data that mortality opportunities with safe are accessible and impacted by Team 1 sleep and other stakeholders work ● Integrate data efforts across Team 1, rather than organized as Data Workgroup

6) Improve communication on partners' policy efforts focused on maternal, infant, sexual and reproductive health, and health disparities

● Support efforts to expand Medicaid coverage from 60 days to 12 months postpartum

● Medicaid postpartum extension (60 ● Follow up on implementation of days to 12 months) funding secured Medicaid postpartum extension for 2022 budget ($5.8 million ● Create policy priorities “Wishlist” to appropriation, HB1600) share with interested policymakers ● Supported other legislative efforts in ● Plan for 2023 legislative session the 2022 session, e.g., Reproductive Health Equity Act, abortion “housekeeping” bill to clarify state’s existing abortion law (APRNs can now provide abortion care and the two laws now contain conflicting language)

June, 2022

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ECAS Team 2: Safe & Nurturing Families ECAS TEAM 2

THEORY OF CHANGE

CONVENERS

Team 2 is working to reduce family violence and support safe and nurturing families by 1) building awareness and understanding of the issue of family violence and 2) building the skills needed to improve the quality of interactions that shape family wellbeing and prevent family violence.

When young children are raised in safe and nurturing homes, they are more likely to develop on-track and reach school ready to thrive.

● Kanoe Enos (A‘ali‘i Alliance) ● Shelly Tokunaga-May, EdD (A‘ali‘i Alliance)

GOALS

KEY MEASURES OF SUCCESS*

● Reduce family violence in homes with young children ● Strengthen early childhood providers’ capacities to support families and refer families at-risk ● Educate the public about the prevalence of family violence and the impact to young children ● Strengthen our systems of support for families

OUTPUTS

Family Engagement: ● 300-500 families will receive toolkits ● Participating families complete and return surveys on the toolkits ● Families receive educational and resource materials/info, including referrals to support services Service Provider Support: ● Trainings developed & delivered to 20 service providing organizations ● 75% of staff in those organizations participate in the training ● 40 participating programs display/use Aloha at Home messaging

OUTCOMES

Short Term: ● Increase in families taking advantage of available family supports (including: AUW-211, Keiki Central, Domestic Violence Action Center, Parenting Line, and other referral lines ● Increase in utilization of family support services ● Increased referrals of families to support services ● Increased community awareness about family violence and creating safe and nurturing homes

Medium Term: ● Decreased rate of reports to DHS with Community Messaging: concerns about child abuse & neglect and ● Increase in visits to / links to the Aloha at intimate partner violence Home/Nurture Daily website ● Decreased rate of substantiated cases of ● Materials on safe & nurturing families & child abuse and neglect and child development developed / ● Decreased rate of intimate partner distributed through community events violence/domestic violence

For more information, see: https://hawaiiactionstrategy.org/dashboard -goal-2

Long Term: ● Reduced rates of family violence to include child abuse and neglect and intimate partner violence ● Reduced number of children referred to child welfare services ● Increase in children arriving at kindergarten ready for school-success

*Some teams can track their key measures of success while other teams are still working to define appropriate measures

June, 2022

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ECAS 6-Month Progress Report

SAFE & NURTURING FAMILIES STRATEGIES

ACTIVITIES

1) Develop a Safe and Nurturing Families framework to reduce child abuse and neglect (CAN) and intimate partner violence (IPV) (i.e., Aloha at Home ~ Nurture Daily)

● Develop the Aloha at Home: Nurture ● Continued development of ● Continue to refine the framework with Team Daily Framework, based on: framework, weaving together the 2 so that all 5 years of messaging is familiar ○ 5 Frameworks Themes themes and protective factors, and and ready for roll out with Team 2 service ○ 5 Protective Factors newly incorporating Aunty Pilahi providers. ○ Sequenced roll-out Pakīʻs foundations of ALOHA. This ● Assuming Honolulu Grants in Aid funding is ○ Cultural responsiveness framework serves as the foundation received, participate in community events, ● Secure resources and establish for all future direct services, and conduct social media activities on infrastructure for roll-out and advocacy, and messaging work for framework, and roll out toolkits via implementation of framework and Aloha at Home. partnering service-provider organizations to associated action plan ● Pursued funding opportunities to families on Oʻahu. ● Roll-out framework with early sustain the initiative through ● Pursue additional funding to support roll-out adopters – DHS, WIC, Head Start, governmental and private foundation and activities in neighbor islands.

Zero-to-Three Court sources to support implementation (including submission of Hawai‘i Children’s Trust Fund proposal, Funders Hui memos) ● Building capacity within Team 2 service providers to understand and use the Aloha at Home framework in their work via activities during Team 2 meetings. Incorporated capacitybuilding of service providers into HCTF proposal.

Framework to be: ● Strength-based ● Skills-focused ● Based on validated national research ● To be used by the network of practitioners

2) Implement a community-wide messaging and media campaign

June, 2022

KEY ACHIEVEMENTS JAN-JUNE 2022

● Develop 5-year, sequenced messaging plan based on Aloha at Home framework that appropriately scaffolds from one theme to next ● Develop culturally appropriate messaging content built on the components of the Aloha at Home framework (themes, protective factors, etc.) ● Develop materials/collateral for use in messaging efforts (photos, graphics, logos, etc.) ● Deploy messaging via: ○ Website ○ Social media ○ Community events ○ Traditional media ○ Service-provider engagement ● Develop and expand the Aloha at Home “Ohana Boxes” (family toolkit) effort, sharing materials directly with families to strengthen their positive interactions in the

● Messaging plan development (including timing [& time frames] of roll-out of messages, deployment of content, alignment across venues & activities) ● Participated in Hoʻoikaika Child Abuse and Neglect month activities by contributing social media posts, providing prizes for participating families, and collaborating with the team to plan the months activities ● Expanded focus on social media avenues to drive traffic to website – expanding use of ‘intrinsic marketing’ to reach broad audiences w/out an advertising budget ● Revamped Nurture Daily website via change to Aloha at Home domain name/web address and rebranding/redesign of site to incorporate new logos, graphics, collateral, etc. Incorporated info on ALOHA values to reflect updated

www.HawaiiActionStrategy.org

6-MONTH TARGETS JUL-DEC 2022

● Continue to refine the framework with Team 2 so that all 5 years of messaging is familiar and ready for roll out with Team 2 service providers. ● Continue to build out the website to reflect the Aloha at Home framework, store messages and content, and be a repository for tools for service providers ○ Mine data to determine if the website is driving traffic to needed resources ○ Increase referral of families to services via the website ● On-going expansion into social media ● Use Hoʻoikaika coalition to better understand the needs of families (i.e., environmental scan) ● Seek feedback from ECAS Fatherhood workgroup to inform development of messaging, website, social media, and toolkit contents ● Work with service providers to create a pipeline for toolkits to go to families with

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ECAS 6-Month Progress Report

SAFE & NURTURING FAMILIES STRATEGIES

ACTIVITIES

home and provide resource information on support services to meet their needs ○ Design and develop content and collateral ○ Implement direct distribution to families ○ Facilitate expanded implementation and distribution via capacity-building of partner organizations

KEY ACHIEVEMENTS JAN-JUNE 2022

6-MONTH TARGETS JUL-DEC 2022

framework. Increased focus on family engagement w/the addition of activity pages tied to toolboxes and more family-friendly messaging and informational content ● Working on development of more collateral materials that will align w/protective factors & themes

greatest needs (via Honolulu GIA and HCTF funding, if received) ● Expand the reach of the program via scaling & replication, with modifications based on lessons learned from the prototype (developing an iterative feedback & learning loop)

3) Develop family strengthening core ● Engage with service providers to ● Introduced the concept of aligning competencies and training for early strengthen the care and response approaches of service providers with child practitioners/ service providers safety net Aloha at Home framework and ● Develop provider-focused, content informational and resource content ● Continued to build out the website to for the Aloha at Home website support service providers (in addition ● Develop and provide trainings on to families) the Aloha at Home framework, (protective factors, themes, messaging, etc.), family toolkits, and how to use the toolkits with families ● Support and facilitate access to expanded professional development opportunities related to family strengthening, the 5 Protective Factors, and family violence 4) Create a family support system that connects families to support programs from the prenatal period through childhood

June, 2022

● Increase awareness of families and service providers of resources and support services for families ● Expand capacity of service providers/professionals to engage families around family violence and creating safe and nurturing homes and to refer families to support services ● Ensure all family-strengthening resources are included in information and referrals provided to families ● Create spaces and opportunities for relationship-building between families to expand healthy social support networks (e.g., online, and

● Work with Team 2 providers to develop and use Aloha at Home materials at their organizations ● Gather materials from service providers to incorporate into Aloha at Home messages, website, and activities ● Funds permitting, share Aloha at Home activities and framework with service providers (e.g., training); funds not permitting, continue to use Team 2 as the primary venue for rolling out service provider development ● Continue to support and encourage expanded professional development opportunities related to family strengthening or with content related to the Aloha at Home framework

● Determined what organizations have ● Include services and resources as part of families and clients that could benefit Aloha at Home activities, messages, and from connecting and building a website to direct families to supportive support system, including increasing services directly, without referral being collaboration with organizations like needed Hoʻoikaika ● Create activities within Aloha at Home that highlight service providers and programs, social support networks, events, and community resources

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ECAS 6-Month Progress Report

SAFE & NURTURING FAMILIES STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN-JUNE 2022

6-MONTH TARGETS JUL-DEC 2022

in-person events and activities bringing families together) 5) Identify policy opportunities to strengthen family safety

June, 2022

● Support potential legislation to ● Assisted in development of ECAS ● Strategize and increase advocacy and expand family strengthening policy framework and ECAS issue engagement related to family violence supports brief on Family Violence prevention/intervention policy measures, ● Support policy measures addressing ● Identified legislative priorities for based on overall poor/disappointing family violence intervention and 2022 Session related to family outcomes for 2022 Session prevention violence prevention and intervention and family strengthening ● Served as key informants and champions for priority bills/ measures and contributed to testimony and advocacy efforts for the 2022 Session. Bills successfully passed include: ○ HB 1741 - Children and Families of Incarcerated Individuals ○ SB3111 - Family Resource Center pilot ○ HB2510 - Earned Income Tax Credit and Minimum Wage

www.HawaiiActionStrategy.org

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ECAS 6-Month Progress Report

Team 3 – On-track Health & Development ECAS TEAM 3

THEORY OF CHANGE

CONVENERS

● Team 3 is working to ensure all children are supported to reach their optimal development by working with early childhood and healthcare providers and families.

● When children with developmental concerns are identified early, the sooner supports can be provided to promote their optimal development. ● Building lifelong healthy habits starts prenatally and extends into early childhood. Children that are regularly offered opportunities to eat healthy, culturally appropriate foods and engage in physical activity reduce their risk for chronic diseases in adulthood. ● Additionally, children are more likely to thrive when their physical and mental well-being needs are addressed, and their families have the knowledge, skills, and resources they need to be strong advocates for their children’s health, wellness and early learning.

● Keiko Nitta (DOH) ● Cherilyn Shiinoki (Family Hui Hawai‘i) ● Jordan Smith (DOH)

GOALS

KEY MEASURES OF SUCCESS*

● Ensure all children, especially those at-risk, get screened at AAP recommended ages, are provided with appropriate referrals, and access those services ● Ensure there is communication with the medical home and early childhood programs ● Ensure childhood obesity prevention best practices and standards are understood, supported, and implemented in early childhood programs ● Ensure young children’s social and emotional development is supported by childcare providers, medical and health care providers and parents and families

Key Measures: ● # Of children (0-3 years) who have had a developmental screening ○ Data source: National Survey of Children’s Health, Indicator 4.10 ● # Of children (0-5) having a medical home ○ Data source: National Survey of Children’s Health, Indicator 4.12 ● # Of children (2-8) overweight or obese ○ Data source: UH Manoa Children’s Healthy Living Program ● # Of early childhood programs implementing childhood obesity prevention best practices ● # Of young children (age 6 months - 5 years) who are flourishing ○ Data source: National Survey of Children’s Health ○ “Flourishing” defined by how often a child is affectionate and tender, does child bounce back quickly when things do not go his/her way, does child show interest and curiosity in learning new things, and does child smile and laugh; must be “always” or “usually”

*Some teams can track their key measures of success while other teams are still working to define appropriate measures

ON-TRACK HEALTH & DEVELOPMENT STRATEGIES

1)

ACTIVITIES

Create a framework for a ● Engage families in learning about screening- referraltypical developmental milestones utilization of services in bite-size family-friendly pieces feedback loop within the supported by tangible follow up medical home model activities to practice what was learned. ○ PDGB5 MFKE Strategic Implementation Plan Objective 1: Family Focused - Develop and implement learning opportunities for families

June, 2022

KEY ACHIEVEMENTS JAN – JUNE 2022

6-MONTH TARGETS JUN - DEC 2022

● Continued to support the implementation of the CDC Act Early materials and consider looking at hearing and vision screening and use of a social determinants screening tool. ● Assessed & identified alignment with screening & referral activities in: ○ ECCS grant ○ HCF Screening initiative ○ EPSDT Med-QUEST efforts

● DOH will contract Family Hui to help conduct presentations on CDC Act Early materials. Family Hui will conduct presentations on the CDC materials (books, app, handouts) to promote child development to Team 3 participants as requested. ● DOH to draft screening process maps on developmental, hearing, and vision screening to share with Team 3 and other stakeholders. For

www.HawaiiActionStrategy.org

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ECAS 6-Month Progress Report

ON-TRACK HEALTH & DEVELOPMENT STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN – JUNE 2022

utilizing best practice materials and models that build their capacity to be engaged in their child's development.

6-MONTH TARGETS JUN - DEC 2022

example, developmental screening processes using LDAH’s School Readiness Programs and explanations of the Early Intervention Section’s information on what happens to the referrals and timelines have been drafted to share with Team 3 and other stakeholders.

2) Increase the number of children enrolled in a medical home

● Promote families’ understanding of ● Continued to monitor use of telehealth vs. in-person medical home visits ● Promote use of telehealth through technology. Make sure families have access to technology and participate in program partner activities that promote support through virtual/online engagement. ○ PDGB5 MFKE Strategic Implementation Plan Objective 1: Family Focused - Develop and implement learning opportunities for families utilizing best practice materials and models that build their capacity to be engaged in their child's development.

● DOH working on an agreement with Med-QUEST for data on # of telehealth visits to share and discuss with Team 3. Data will include a comparison of well child visits conducted in-person vs. through telehealth.

3) Embed childhood obesity prevention best practices into the early childhood system

● Create and deliver trainings to ● Conducted follow up survey and held 1:1 meeting with support Physical Activity and Healthy Keiki in ECE Settings meeting attendees to Nutrition Increase knowledge and identify action plan champions and understand awareness of Early Childhood barriers to action plan implementation.

Wellness Guidelines; assess current ● Secured $200,000 in funding and technical assistance levels of implementation; identify to support implementation of the Healthy Keiki in ECE training and technical assistance Settings created in partnership with the National needs; develop system of support Association of Chronic Disease Directors. Funding and for implementation; deliver technical assistance secured through the Nemours professional development and Healthy Kids Healthy Future technical assistance other resources as needed; evaluate program (HKHF TAP). on-going progress ● As part of the Nemours HKHF TAP initiative, ○ PDGB5 MFKE Strategic developed a state action plan, and contracted with Implementation Plan: Objective 2. partner organizations and consultants to support Provider-focused. Develop and farm-to-keiki professional development and implement learning implementation efforts, pilot childcare local food opportunities for providers of all incentive program, and assess development of a types utilizing best practice possible health and wellness-focused provider materials and models. recognition program

● Close out activities and reporting from Year 4 of the Healthy Kids, Healthy Future Technical Assistance Program. ● Develop and implement a Year 5 action plan for Healthy Kids, Healthy Future Technical Assistance Program to embed childhood obesity prevention best practices into ECE systems and settings. ● Develop shareable materials (i.e., presentation, one pager etc.) and data dissemination plan for Hawai‘i ECE Children’s Health Survey results.

June, 2022

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ECAS 6-Month Progress Report

ON-TRACK HEALTH & DEVELOPMENT STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN – JUNE 2022

6-MONTH TARGETS JUN - DEC 2022

● Collected and analyzed data from more than 3,000 families statewide with young children ages five and under that participated in the 2022 Hawai‘i ECE Children’s Health Survey (survey fielded in November 2021). Information collected includes information on the built environment, childcare, food access, oral health, and more. Created a summary 42-page report.

4) Promote social and emotional health of infants and toddlers

June, 2022

● Promote Infant and Early Childhood Behavioral Health plan and environmental scan of resources and share with stakeholders. ○ PDGB5 MFKE Strategic Implementation Plan: Objective 3: Community-focused. Generate increased community understanding and support for family engagement and child development. ● Support implementation of LENA programs, which facilitate social emotional development, attachment and parent-child engagement through interactive talk and reading together. ○ PDGB5 MFKE Strategic Implementation Plan Objective 1: Family Focused - Develop and implement learning opportunities for families utilizing best practice materials and models that build their capacity to be engaged in their child's development.

● Worked with IECBH Coordinator to support focus ● Review and discuss updates to groups on behavioral health in the communities.

IECBH Plan and decide on role of ● Continued and expanded use of LENA programs and team and individual members. technology on Maui and Oahu to support social● Discuss family-friendly terms to emotional development and literacy connections with reduce stigma on the term “mental families, childcare and early learning providers, EIS health” in partnership with DOH and interventionists, and with mothers with infants and a communications team. toddlers in substance use recovery program ● Expand LENA Grow coaching ● Developed supports and processes for successful support to Family Child Care implantation of virtual LENA programs providers through an upcoming ● Expanded network of partners leading implementation family childcare conference provided of LENA within their own programs. by the DOH. Increase family engagement and partnerships between FCC providers and their families. ● Expand direct family participation in LENA Start and Home programs. ● Expand LENA SP participation through EIS.

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ECAS 6-Month Progress Report

Team 4: Equitable Access to Programs & Services ECAS TEAM 4

THEORY OF CHANGE

CONVENERS

Team 4 is working to increase access to existing early childhood programs and services throughout the state and to resolve program/ service gaps community by community.

When families with young children can access needed programs and services, those children are more likely to develop to their full capacity and reach school ready to thrive.

● Ka‘ina Bonacorsi, Maui County Early Childhood Resource Coordinator ● Angela Thomas, Hawai‘i County Early Childhood Resource Coordinator

GOALS

KEY MEASURES OF SUCCESS*

● Increase access to existing early childhood programs and services throughout the state. ● Resolve program/service gaps community by community.

Co-Conveners continue to work on measures that align with each subgroup’s activities. This conversation will identify Key Process Indicators (KPI), output measures, and measures of population-level change (outcomes).

Conveners & backbone are meeting biweekly and are collecting data from Team 4 members.

Conveners will develop a draft set of measures and then meet with the team to review (by end of Q3).

Potential measures to capture and track include: ● Children enrolled in licensed / regulated care, by age group, provider type, and geographic area (Included on ECAS Child Care Capacity dashboard, but age group data is weak) ● Children enrolled in DHS subsidy (CCC & POD) and other subsidy programs, by age group, provider type, and geographic area (not currently collected) ● Provider licensed & desired capacity (by zip code) (Available on ECAS Child Care dashboard quarterly) ● Workforce capacity (by license type) ● Children in homeless families enrolled in early learning programs (# & %), ● Share of eligible families accessing DHS subsidies, and ● Families participating in family/fatherhood engagement programs (survey census of nonprofit providers re: # of families served) The team is reviewing some possible examples of key metrics to track, relating to access to early childhood learning and family support.

On the eve of the pandemic (in February 2020), Hawai‘i had 25,247 child care spaces in facilities regulated by the Hawai‘i Department of Human Services, including: ● 21,934 seats in childcare centers ● 1,514 spaces in infant-toddler centers, and ● 1,799 spaces in family childcare homes As of October 2021, there were 107,493 children under age six in Hawai‘i ● 64,172 of these children (59.7%) have all parents in the workforce, and need non-parental childcare ● 33,755 of these children (31.4%) live in families in or near the federal poverty level Meanwhile, in March 2022 statewide, there were: ● 735 childcare providers registered with PATCH, with a combined capacity to care for 20,975 children ○ Compared to pre-pandemic levels, this represents a 12% reduction in the capacity of the childcare sector to care for children aged 0-5.

*Some teams can track their key measures of success while other teams are still working to define appropriate measures

June, 2022

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ECAS 6-Month Progress Report

EQUITABLE ACCESS TO PROGRAMS & SERVICES STRATEGIES

ACTIVITIES

1)

● Increase share of income eligible ● Building business and admin capacity of providers families applying for childcare and continued expansion of FCC-specific supports: subsidy support ○ Participated in FCC Advisory group, informing ● Partner with the DHS Child Care ongoing development of Shared Services and office to revise childcare subsidy Pathways projects (see FCC update, above, for administrative rules details on progress/achievements of projects) ● Engage businesses in supporting ○ Advocated for growth of Shared Services and FCC employee access to childcare via business/admin support services via state events or childcare related legislation (DHS/CCPO) and local (County government) ● Strengthen and expand support for funding opportunities FCC providers, including ● Addressing I/T workforce issues: accreditation support ○ Met with DHS to explore alternatives to ● Increase engagement of IT providers experiential requirements for center-based staff in training opportunities (e.g., waivers, exceptions, pilots, policy changes, ● Support growth of IT workforce and etc.) and obtained information from national small business start-ups for IT care workforce clearinghouse on I/T staff via needs assessment requirements in other states research/studies ○ Participated in PD/webinars on compensation ● Support funding, materials strategies and engaged in advocacy work during development and activities for Leg session on workforce wage-subsidy pilot existing family outreach, education, (SB2701) and engagement efforts (e.g., Little ● Advocacy and policy work related to publicly funded Minds Matter, Vroom, Family Hui) (i.e., subsidized) I/T care: ○ Met with DHS/CCPO and engaged with HECAA and national informants on conducting statewide cost estimation and rate modeling study to revise subsidy reimbursement rates ○ EHS Rising state policy agenda developed and readied for distribution

The Infant/Toddler (IT) subgroup is working to increase the access of children birth through 3 years of age to quality early care and education services by addressing policy/ regulatory/ funding barriers, supporting quality- improvement and capacity-building activities, and engaging new partners/ advocates from other sectors of the community.

2) Child Homelessness ● Expand the number of EC Action Team (CHAT) is programs/settings supporting working to increase children experiencing homelessness access for children in ● Expand the number of enrolled unstable housing to early children experiencing homelessness care and education in EC programs/settings programs and services ● Leverage existing data sources to gain a clear picture of where to target services for homeless children ● Raise awareness about child homelessness/ Increase public awareness about young children experiencing housing instability ● Develop a systematic data collection tool/methodology for assessing numbers of children, birth to five, experiencing homelessness and June, 2022

KEY ACHIEVEMENTS JAN -JUNE 2022

● Workgroup did not actively meet over the 6-month period, however workgroup Lead and stakeholders continued efforts around strategies and activities ● A statewide B-5 Navigator position was created and filled to explore ways to increase numbers of children served in EC programs/settings (e.g., contract for slots in EC programs or site expansion of programs) through ARPA funding for Homeless Children and Youth ● Meetings with Early Intervention Services and Honolulu YMCA were conducted to support the HIDOE Education for Homeless Children and Youth (EHCY) program in their efforts to connect more birth to five keiki to early childhood programs and settings

www.HawaiiActionStrategy.org

6-MONTH TARGETS JUNE - DEC 2022

● Advance cost-estimation study in partnership with HECAA efforts ● Develop issue brief on I/T care in the context of PreK expansion ● Deploy survey exploring families’ I/T childcare preferences and key barriers constraining choice ● Work on admin/policy issues impacting family childcare capacity and I/T workforce development ○ Conduct crosswalk of I/T teacher experience requirements in other states ○ Develop admin-rule change recommendations and/or pilot waiver proposals for expanding I/T experience qualifications ○ Identify strategies for addressing land use/zoning barriers to FCC capacity (Honolulu) ● Work with HCAN on advancement of general I/T issues articulated in EHS Policy Agenda

● Work with new B-5 Navigator to support EHCY in efforts to connect more children experiencing homelessness to EC programs/settings ● Identify possible policy recommendations and use newly published ELH brief as source document to establish need ● Work with Partners in Care on Oahu and initiate partnership with Bridging the Gap (BTG) Continuum of Care on Neighbor Islands ● Reconvene Data subgroup to develop and implement data collection methodology to assess numbers of children, birth to five, experiencing 35

ECAS 6-Month Progress Report

EQUITABLE ACCESS TO PROGRAMS & SERVICES STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN -JUNE 2022

numbers being served in EC programs/settings

6-MONTH TARGETS JUNE - DEC 2022

homelessness and numbers being served in EC programs/settings

3) Fatherhood Engagement subgroup is working to increase the positive involvement of fathers and other men in the lives of young children.

● Identifying Existing Resources and unmet needs of fathers and other men with responsibility in the lives of young children ● Increasing Leadership and Championing of Fatherhood Initiatives ● Impact the Early Childhood Field to Intentionally Engage and Include Fathers and ● Expand the focus of fatherhood engagement opportunities to include early childhood

● Liaised with ECAS teams 1, 2 & 3 to better understand how their work might be strengthened by a stronger engagement with the Fatherhood subgroup and explore opportunities to work collaboratively.

● Build and pilot test a father engagement survey (to go directly to dads) (Q1 2022) ● Identify key indicators that affect fatherhood programming to be added to the community profile effort (building our understanding of key indicators concerning fatherhood) (Q2 2022)

4) Family Engagement and Supportive Partnerships subgroup is working to increase access to services for family engagement and parent leadership

● Increase parent engagement in a child’s life, and encourage program supports and family partnership ● Improve/access of the supports available for programs and families to develop healthy partnerships

● This subgroup has been put on hold during the COVID-19 outbreak, and will be resumed after the virus has passed ● Convene subgroup, recruit/confirm members and establish workplan (still on hold given other priorities)

● Setting targets will happen after the subgroup reconvenes

5) Neighbor Island ● Extend the networking effort to other Networking subgroup is counties & islands working to strengthen ● and integrate county and island-level early childhood systems and networks across Hawai`i.

June, 2022

● Community Profiles: ● Complete early childhood profiles for ● Developed a community profile advisory group to Kauai and Honolulu counties identify key indicators of early childhood wellbeing ● Onboard Honolulu and Kauai and at the County or community level. begin convening County ● Secured funding hui support to initiate the coordinators/staff for all islands community profile project ○ Establish workplan and targets ● Hired a contractor to undertake the work, in ● Expand the number, type, and quality collaboration with the advisory group of info of neighbor-island resources ● Brief data summaries completed for Maui & Hawai‘i and services included in revamped/ Counties, available on the ECAS website retooled Keiki Central ● Extensive narrative reports for both counties in development, anticipated completion in Q3 ● Desktop publishing support contracted to complete final versions of these reports, including detailed, extensive indicator tables as appendices ● Funders hui request submitted for Kauai and Honolulu Counties (funding secured for Kauai) ● Expansion of Neighbor-Island systems: ○ County-funded early childhood coordinator established for Hawai‘i County and resourced with $7M for systems/capacity-building

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ECAS 6-Month Progress Report

EQUITABLE ACCESS TO PROGRAMS & SERVICES STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN -JUNE 2022

6-MONTH TARGETS JUNE - DEC 2022

○ Honolulu County specialist, supported by HCF funding, in process of being hired ○ Kauai County engaged in discussion to assign staff person to early childhood issues ● Advocacy/policy: ○ Initiated legislation (SB 2038) to expand membership on the Early Learning Board to provide representation for each County and its unique needs and landscape on the Board ○ Bill failed but associated resolutions (SR30, SCR34) charging ELB to review membership and representation were adopted 6) Use technology to ● Create a revised Keiki Central efficiently connect platform, focused on programs and families and providers to services for keiki prenatal to age 8, early childhood services linked to AUW 211 database. The and resources across the platform will include maps by zip islands code and text, email, phone, and 7) Develop a better interpretation support from the 211 understanding of what team types of early childhood ● Ensure that Keiki Central is linked to services and resources PATCH, DHS and Center on the families are seeking and Family childcare maps where, to inform how ● Explore data sharing agreements partners can fill gaps between EOEL and PATCH, ensuring that childcare and preschool data can be accessed in one place ● Fundraise for initial build out of Keiki Central and Y2 expansion of Center on the Family maps and to secure sustaining funding sources ● Digitize existing resource lists and work with programs and services to keep their information up to date on an annual basis ● Conduct statewide outreach to programs and services to make sure they are listed in the 211 database and the PATCH/DHS database ● Once completed, advertise, and promote the use of Keiki Central, PATCH, DHS, and Center on the Family maps statewide

June, 2022

● Sync Savvy is designing the revised Keiki Central platform and working to ensure that Keiki Central can pull down the most accurate early childhood resources and services from the AUW 211 database ● Links between PATCH, DHS, Center on the Family and Keiki Central are actively being worked on. All partners intend to link to each other’s maps ● EOEL and PATCH have not begun discussions about data sharing ● $100,000 of the estimated total $204,735 secured.

Center on the Family is working to reduce their overhead costs to bring to total amount needed down by about $20,000

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ECAS 6-Month Progress Report

ECAS Team 5: High-quality Early Learning Programs ECAS TEAM 5

THEORY OF CHANGE

CONVENERS

Team 5 will develop a comprehensive personnel development (CSPD) system to strengthen and sustain an Early Childhood (EC) workforce that provides meaningful outcomes for children with special needs, birth to five and their families.

High quality programs and services support early childhood development, and continued quality improvement ensures a highly skilled Early Childhood workforce.

8) Stacy Kong, Early Intervention, Dept. of Health 9) Kerrie Urosevich, ECAS

GOALS

KEY MEASURES OF SUCCESS*

● Provide children with early childhood (EC) services that support their optimal development and prepare them for kindergarten ● Develop a statewide system that promotes professional and workforce development and retention in EC ● Create a shared professional standards and data system to ensure quality

● ● ● ● ● ● ● ● ● ● ● ● ●

Increased # of providers who are culturally and linguistically responsive to Hawai‘i’s keiki A leadership team is in place to set priorities & make policy, governance & financial decisions Increased # of providers follow national professional organization personnel standards Across disciplines, criteria for state certification, licensure, etc. are aligned to state personnel standards & national standards Increased # of providers graduate from IHE (institutions of higher education) programs Increased # of IHE programs and curricula are aligned w/national & state standards Increased # of providers access statewide in-service Professional Development / Technical Assistance opportunities There is a statewide system for in-service PD/TA that is aligned & coordinated w/ IHE programs & curricula Increased # of incentives for workforce training & engagement Recruitment / retention strategies result in a workforce supply that meets system needs Increased # of professions with professional competencies Increased rates of retention in workforce There are adequate & sustainable funding streams supporting system capacity

*Some teams can track their key measures of success while other teams are still working to define appropriate measures

HIGH-QUALITY EARLY LEARNING PROGRAMS STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN-JUNE 2022

6-MONTH TARGETS JUNE - DEC 2022

1)

● Ensure cross-sector representation ● Establish a management process for teams ● Establish a sustainability plan ● Create a CSPD marketing & outreach plan ● Align integrated CSPD with state policies and other EC initiatives ● Increase understanding of current EC workforce policies and initiatives ● Align personnel standards across early childhood sectors

● CSPD website went live Q1 2022 ● Included CSPD commitment blurb in appropriate MOUs for sustainability purposes ● Uploaded onboarding documents in the CSPD team’s shared google drive. ● Began developing the Facilitation 101 materials ● a stakeholder meeting in July with a focus on CSPD updates and feedback on the workgroup Action Plans and in September with a focus on integrating the EIECSE standards. ● Drafted a Business Plan, including a training registry, a budget and timeline ● Formed a team to focus on funding ● Identified a home for the CSPD Coordinator within PATCH

● Finalize and implement Facilitation 101 modules. ● Host a stakeholder meeting with a focus on CSPD updates and feedback on the workgroup action plans. ● Finalize the Business Plan and secure initial funding for CSPD, with the priority being a CSPD Coordinator ● Initiate the Training Registry.

Create a CSPD Infrastructure for the State

June, 2022

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ECAS 6-Month Progress Report

HIGH-QUALITY EARLY LEARNING PROGRAMS STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN-JUNE 2022

6-MONTH TARGETS JUNE - DEC 2022

2) Adopt and integrate the EI-ECSE Standards

● Align state professional standards to EI-ECSE standards ● Establish definitions for certification, licensure & endorsement in Hawai‘i ● Identify commonalities and gaps between current state and EIECSE standards across disciplines ● Strategies to address identified gaps

● Finalized definitions for certification, licensure and endorsement by profession and post on CSPD website ● Planned a stakeholder meeting in September with a focus on understanding and integrating the EIECSE standards into respective agencies. ● Identified commonalities and gaps between current Hawai‘i and national EI-ECSE standards. Standards are listed by profession on the new website

● Host a stakeholder meeting with a focus on understanding and integrating the EIECSE standards into respective agencies. ● Draft a plan for integration of EIECSE Standards across the system

3) Ensure preservice preparation programs across disciplines align to national professional standards

● Identify Hawai‘i preservice preparation programs ● Identify core competencies for each program ● Map coursework across programs ● Crosswalk preservice programs and curricula to EI-ECSE Personnel Standards & cross disciplinary competencies

● Distributed the Preservice survey in Q1 ● Analyzed survey data Q2 2022 to identify: ○ Preservice programs and coursework that align to the EIECSE standards ○ Gaps in alignment

● Targets TBD based on data. Revise workgroup Action Plans based on survey results.

4) Ensure statewide systems for inservice PD and TA are aligned and coordinated across disciplines

● Crosswalk of current training and TA initiatives that align across systems ● Develop rubrics to align PD content to the DEC Recommended Practices and six features of effective PD ● Develop family needs assessment ● Identify gaps in training ● Address training gaps

● Distributed survey in Q1 2022 ● Analyzed survey data in Q2 2022 to identify: ○ PD opportunities that align to the EI-ECSE standards across EC systems ○ Gaps in training/PD opportunities

● Targets TBD based on data. Revise workgroup Action Plans based on survey results.

5) Recruit and retain staff across the EC system.

● Develop comprehensive recruitment strategies using multiple data sources ● Identify current recruitment strategies ● Assess the effectiveness of current recruitment strategies ● Conduct a systematic review of other recruitment strategies ● Develop a list of effective recruitment strategies

● Distributed the R&R survey in Q1 2022 ● Analyzed and reported on survey responses in Q2 2022 ● Identified strategies to support cross sector groups with recruitment and retention of staff

● Targets TBD based on data. Revise workgroup Action Plans based on survey results.

June, 2022

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ECAS 6-Month Progress Report

HIGH-QUALITY EARLY LEARNING PROGRAMS STRATEGIES

6) Develop sustainable mechanisms to collect and analyze data across all 6 subcomponents

June, 2022

ACTIVITIES

● Develop a CSPD logic model for team leads to follow ● Develop evaluation questions, identify data sources, methods, person responsible, timelines and milestones for the evaluation plan ● Develop a checklist for milestone indicators ● Ensure evaluation plan is monitored and revised as necessary ● Use evaluation findings to inform state stakeholders, workgroup, practice inputs ● Develop a dissemination plan for products and materials developed by the subcomponent workgroups

KEY ACHIEVEMENTS JAN-JUNE 2022

● With Part C ARPA dollars, contracted with the Center on Disability Studies to collect and analyze the CSPD surveys. Q 2 2022

www.HawaiiActionStrategy.org

6-MONTH TARGETS JUNE - DEC 2022

● Secure funding for ongoing evaluation support, to include a sustainable process for collecting data overtime.

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ECAS 6-Month Progress Report

Team 6: Successful Early Childhood Transitions ECAS TEAM 6

THEORY OF CHANGE

Working with families and communities to strengthen transitions through early childhood and into school

Strong early childhood family language and literacy practices support optimal early childhood development and school readiness

GOALS

KEY MEASURES OF SUCCESS*

● Increase the number of families engaged in early childhood language & literacy interventions ● Target strong early language and literacy development efforts to communities of greatest need, leading to the development of a pipeline for early reading, kindergarten readiness and early academic achievement ● Increase the number of communities across Hawai‘i with an active early childhood team [On hold]

Team 6 is working to increase the number of: Children & parents enrolled in early literacy interventions. ● One key set of interventions that we have been tracking is the LENA (Language ENvironment Analysis) suite of programs.

To date: ● 308 families in Hawai‘i have participated in Words Matter / LENA programs (between September 2019 and June 2022), including: 171 in LENA START, 35 in LENA Home, 100 in LENA GROW, 2 in LENA SP

CONVENERS

● ●

Kara Kusunoki, Catapult Learning Doug Imig, ECAS

Reach traditionally underserved, at-risk families ● On Maui, 44% of participating families have < high school degree & 50% of families are Native Hawaiian or Pacific Islander ● On Oahu, 62% of participating families have < high school degree & 77% of families are Native Hawaiian or Pacific Islander Gains associated with participation in LENA programs in Hawai‘i: ● Families exit the LENA program with stronger early literacy practices, including: ● # Of adult words spoken to children ○ 10% increase (Maui) ○ 6% increase (Oahu) ● Early childhood language development gains (evident on child development snapshots -- a parent questionnaire that measures a child’s receptive and expressive language development. Evidence to date shows a: ○ 33% gain on Maui ○ 9% gain on Oahu ● Improved parent perceptions of self-efficacy and positive interactive behaviors ○ Across all settings, 75% of parents show gains in domains associated with knowledge, efficacy, and behavior ● Early Childhood Education providers (in both center-based care and family home settings) enrolled in the LENA Grow intervention show substantive increases in their classroom language environments. To date: ○ 82% of teachers on Maui achieved Accomplished status (15 or more conversational turns with all their students) by the end of the intervention (a 28% gain) and 45% of teachers achieved Advanced status (25 or more conversational turns with each of their students) (a 67% gain) ○ 47% of teachers on Oahu achieved Accomplished status (15 or more conversational turns with all their students by the end of the intervention) (a 47% gain) ● Increase the share of families who engage in strong early language and literacy practices: ○ Share of families with a young child that sing & tell stories together every day: ▪ 53.2% (NSCH Indicator 6.8 Hawai‘i. 2019-2020) ▪ UP 2.7% from 2018-2019 ○ Share of families with a young child that read together every day: ▪ 39.3% (NSCH Indicator 6.7 Hawai‘i. 2019-2020) ▪ UP 17% from 2018-2019 ○ # of communities across Hawai‘i with an active early childhood team [on hold]

*Some teams can track their key measures of success while other teams are still working to define appropriate measures June, 2022

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ECAS 6-Month Progress Report

SUCCESSFUL EARLY CHILDHOOD TRANSITIONS STRATEGIES

ACTIVITIES

KEY ACHIEVEMENTS JAN-JUNE 2022

6-MONTH TARGETS JULY - DEC 2022

1)

● Expand the # of implementing partners and sites on Oahu & Maui to serve more families

● Maintaining implementation of LENA (Start & Grow) through the Wahiawa collaborative as part of the CLSD grant ● Expanded the number of partners offering LENA programming to include Read To Me International, MEO Head Start, Malama Family Services Maui, and family child care providers on both Oahu and Maui ● Offered LENA SP services to 2 deaf and hard of hearing children receiving services through Early Intervention ● Family Hui Hawai‘i has agreed to take on management & oversight of the LENA program

● Offer a ‘double dose’ of LENA to children and families in Family Child Care settings on Maui. (FCC providers receive LENA Grow coaching, leading to certification.

Meanwhile, families of children in the program receive LENA Home support.) This is the first implementation of LENA programming that will reach children both at home and in their childcare setting. ● The resources needed to provide this double-exposure are extensive. We have learned that FCC providers do not have bandwidth to offer the program to parents

Implement Words Matter / LENA in diverse settings

2) Target strong early language and literacy development efforts to communities of greatest need, leading to the development of a pipeline for early reading, kindergarten readiness and early academic achievement

June, 2022

● Convene an Early Literacy ● Early Childhood Collaborative group continues to meet, and has Collaborative to develop a engaged with Strive Together and Starting Smart and Strong community of practice collaboratives ● Define & identify effective ● Developed and shared a grant proposal for the continuum with early language & literacy the ECAS funders hui. The feedback has been positive, and we development practices now have sufficient commitments of funding to move forward ● Strengthen links between on design and implementation family engagement & language ● In Q1 & 2, a series of preliminary meetings with key / literacy development efforts stakeholders, including Complex Area Supervisors, funders and ● Map the landscape of current County representative in order to understand their interests and early language & pre-literacy the needs of their communities, solidify working relationships, development efforts and plan next steps in developing community-based ● Develop a prototype kindergarten-readiness continua continuum in one community spanning the years from birth through early elementary school

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● Strengthen our community of practice by coming together around key topics (such as the new statewide KEA) ● Initiate conversations with the KaʻūKeaʻau-Pāhoa Complex Area Superintendent ● Establish a plan for meeting regularly with the CAS and school principals in both the Waimanalo & KKP complex areas to build a shared understanding of the needs of the community, existing preferred providers, and to identify gaps in the system of support that might be addressed by continuum partners, Q 3-4 (2022) & 2023 ● Join community leadership tables to introduce the continuum idea and solicit engagement ● Establish a master agreement between ECAS (as lead intermediary association) and DOE to begin to implement the continuum, Q4

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Kerrie Urosevich, PhD Network, Design, and Innovation Lead kerrie@ecashawaii.org Doug Imig, PhD Evidence and Outcomes Lead doug@ecashawaii.org

www.HawaiiActionStrategy.org