EA R LY C H I L D H O O D SYST EM S IM P R OV EMENT AN D S U STA IN A B I LIT Y Promote Aligned and Mutually Reinforcing Activities About half of all states raised challenges in key informant interviews related to the strategy of Promoting Aligned and Mutually Reinforcing Activities (for more details on partnership building, please refer to the Partnership Development section). However, the specific partnership building challenges tended to be specific to each state context. Many of the challenges discussed by states related to getting partners to align their goals and activities when their interests were not originally aligned or appreciating the utility of aligned messaging. For example, New Jersey spoke about competition between partners and how that was a barrier to collaboration, with investment needing to be made to get past the inherent conflict:
“
In our county we have different people working on developmental screening. I think there’s some confusion
by some people, especially the ground-level people trying to figure out the role, the scope, and how it all fits together. We just had a call the other day, and somebody asked another person [if they] could share their contact person and they were like, ‘Well, if it’s not going to compete with what we’re doing.’ They literally said that. But that can be addressed by additional training and information, helping people see how all the pieces fit together. It’s not just with screening – that’s with home visiting and all different things. There [are] always people that feel like we’re competing, but just kind of getting past that in terms of screening and serving children, in terms of developmental health
”
promotion – just trying to figure how everybody can work together and benefit the greatest number of families.
In a similar regard, both Florida and New Jersey discussed their difficulties with gaining trust among partners and the time constraints of grant funding that challenged relationship building. Three states struggled with figuring out how to get partners to work together, and two states expressed frustration with trying to coordinate alignment among partners while simultaneously creating the vision for statewide ECCS implementation. Delaware elaborated on the challenges of coordinating alignment across partners:
“
When we first started this work, there were so many silos. It was definitely a barrier and a challenge trying to get
people out of their mindset of, ‘This is what I do,’ and to try to see the larger picture. It was really helpful, even in the
beginning, when we did some of the swim lanes. [We] really took that landscape and – even throughout this process – it’s like, ‘Okay, we got new swim lanes.’
”
Support Continuous Learning and Improvement Efforts While several states discussed CQI as a key strategy to support ECS improvement and sustainability, only Massachusetts, Alaska, and Hawaii described challenges with this strategy and difficulty in developing CQI processes. Alaska noted the inherent barrier of how small numbers made it hard to understand or improve anything measurably, and related, found it difficult to develop indicators that were useful in measuring the process:
“
One of the things we struggled with is really getting a good CQI process going on, once that was no longer
mandatory. Because of our small numbers, that had always been a little bit of a tricky process, but I think that that’s not necessarily collecting the data that’s most impactful. Everyone’s been very interested in CQI and we talk about it,
”
but really building the momentum with the types of data that we’re collecting has been hard to find.
Colored bolded text refers to the Logic Model. Green = Core Domain Blue = Goal Area Purple = Activity
National Institute for Children’s Health Quality
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