How the MISSISSIPPI THRIVE! project is encouraging young children’s development

Graphic of the state of Mississippi with text saying 1 out of every 20 children under 6 in Mississippi has been diagnosed with a developmental delay.Almost three years ago the SSRC Family and Children’s Research Unit, under the direction of Dr. Linda Southward, was awarded a grant from the Health Resources & Services Administration (HRSA) and began formulating a plan for addressing the needs of children. The funding came through at 10.5 million dollars for three years to be split equally between the SSRC and a team at the University of Mississippi Medical Center. Dr. Southward retired earlier this year after a long and impactful career, setting up the Mississippi Thrive! Child Health Development Project to continue its work by influencing policies, improving children’s health through a network of support, and raising the number of children receiving early childhood developmental health screenings.

“This project is working to improve the early childhood developmental health system in Mississippi. For so many years in Mississippi, we have used grant dollars to conduct interventions,” explained Hanna, the project’s current Principle Investigator at the SSRC, along with Co-Principle Investigator Connie Baird-Thomas. “While temporarily improving problems, this type of work has not been sustainable. Our goal is to embed a stronger emphasis on early childhood developmental health within existing structures and to form connections across institutions to better serve children and families.”

Digital Development

As the researchers looked into ways to sustainably meet the major goals, they connected with many state agencies and VROOM. Vroom is an initiative of the Bezos Family Foundation and has created an app that is a free download for anyone. It shares detailed tips, how to’s, and examples for working with children and marking developmental milestones. Mississippi’s VROOM ambassador is Heather Martin. Martin travels the state sharing about the benefits of VROOM and encouraging parents and guardians to use the app to track their child’s progress through different developmental stages.

VROOM differs from other resources because it has specific tips to help parents engage with their child in small ways like asking them to take turns singing with their child while waiting for an appointment. The app then shares what skills this tip is developing in the child. These tips are available for children from birth to age five.

Brain Building

In addition to working directly with VROOM to influence parents and healthcare workers, the HRSA team is also reaching out through training and materials to work with childcare center staff. The Childcare Practice Transformation team has developed a training that is incorporated into the Mississippi State Department of Health (MSDH) Director’s Orientation training for childcare workers around the state to either retain or gain certification to work in the field.

“We were charged with supporting children’s growth and achievement of early developmental milestones by working through childcare centers and the teachers who are engaging with young children each day,” said Lisa Long, a research associate with the project. “When we thought through how to best reach as many child care center teachers as possible, our HRSA colleagues linked us with Dr. Chad Allgood at MSDH who oversees the Childcare Licensure Division. Through conversations with Chad, we were invited to work with his regionally-based staff who train and support childcare centers across the state.”

These MSDH trainers travel the state of Mississippi providing continuing education training to childcare center teachers and staff. The Childcare Practice Transformation team incorporated their material into MSDH’s “Director’s Orientation” because it is a required training for any new childcare center director or their appointee, and is also a popular training for childcare center staff who are seeking to build up their required number of annual professional contact hours. The material is completed in a three-hour training session.

“We worked with both MSDH’s team and Dr. Alicia Westbrook, the director of the Mississippi Early Childhood Inclusion Center at the University of Southern Mississippi when putting together the training session draft. MSDH gave great feedback on what would complement their current training content, and the Early Childhood Inclusion Center helped us with different ways of looking at inclusion and content on how childcare centers may actively participate in monitoring and enhancing young children’s developmental progress,” Long said.

A draft was completed and reviewed in April of 2019, and the main components centered on the structure and importance of early development. Some of the materials included PowerPoint presentation slides, but other aspects were also included to provide hands-on learning about early brain development such as the “Brain Architecture Game.”

“We hadn’t originally planned to use the game. Instead, we had slides and statistics on the science behind brain development. Then we met with the Frameworks Institute, an organization that is an amazing crafter of messages out of Washington, DC. They work with lots of different content areas, but within the early childhood field, they’ve made a huge difference in the way early childhood professionals effectively convey the meaning and importance of our work with young children and their families. Frameworks suggested using the Brain Architecture game as a way to heighten participant engagement,” Long said.

The game gives participants different scenarios that a child may encounter in their early years and depending on whether those are toxic, tolerable, or positive the participant uses different props to construct a brain. A good card like having responsive, supportive caregivers would allow the brain to be built with a sturdier straw. A toxic card like experiencing severe neglect or caregiver substance abuse would build the brain with flimsier pipe cleaners. The game continues as participants see how each experience builds on another for the child resulting in a strong or unstable foundation for further learning and development.

“Frameworks puts it like this: Use the image of a house being built. A young child’s brain is like a house with many rooms being built and wired up. It is the foundation for the child’s future health, cognition, and behavior, so the foundation needs to be strong for future skills that will be built on top of it,” Long said.

After finishing the game participants will discuss what they learned and observed during the activity, and then they may think about the card scenarios and consider how they would advise the parent if the child was experiencing that situation. Trainers also share resources from the Center for Disease Control and Prevention’s “Learn the Signs. Act Early” guild for developmental milestones children typically reach between two months and five years.

The training has evolved after discussions with the Mississippi Department of Health and their trainers. Through this process, they have added further information on how to have conversations with families around early development and better detailed certain aspects of brain development. So far, the researchers have worked with all of the regional trainers in the state, attending and assisting with MDH trainings in Hattiesburg, Pascagoula, Vicksburg, Brookhaven, and Columbus.

“This fall we are rolling out the second version of the training with some tweaks that we made over the summer,” said Long. “Hopefully, this will be the final version that we will hand over to the trainers to use for years to come.”

Graphic of 10 babies with 3 colored differently to signify the 3 out of 10 children under 6 in Mississippi that have received trainings.

Providers Practices

In addition to working with childcare providers, the SSRC team is also reaching out to healthcare providers, like doctors and nurse practitioners, through its partnership with the University of Mississippi Medical Center. The Healthcare Practice Transformation team, with SSRC leads Connie Baird-Thomas and Sheena Gardner, is looking at ways to support best practices related to developmental screening in pediatric clinics.

“The American Academy of Pediatrics recommends a set schedule for developmental screening. If they are conducted at the appropriate times, then providers can assess children to see if they are progressing as expected.  If they aren’t and intervention is needed, a referral can be made to address the issue,” Baird-Thomas said.

The Health Care Practice Transformation team is also working with practices to introduce more messaging on developmental milestones into their current processes. The team is introducing health promotion messaging utilizing Learn the Signs, Act Early (CDC), Reach Out and Read  and Vroom into waiting rooms and during well-child visits. Once the materials are available, they are working with the doctors to ensure that they are using standardized guidelines and using best practices when discussing them with parents.

“The goal of our team is to work with healthcare providers in their practices to get them to implement or improve their practices for developmental screenings, assessment, and linkage to care. We go into the clinics and talk to them about their regular workflow, the points at which they conduct screenings, and the outcomes as they are related to referral and linkage to services. We let them determine how they would like to improve this process,” Baird-Thomas said.

Literacy Links

As a support component to each of these other teams and the team directly responsible for parent outreach, the Health Literacy group compiles and creates resources to be used in trainings, meetings, and other settings.

“Our health literacy team focuses on community outreach by speaking directly to individuals and filling in the gaps of where our other teams are working with professionals. We support the Health Care Practice Transformation team and Childcare Practice Transformation team in providing messaging to those professionals. We also look at the sustainability of who in the state is already sharing our message and how can we support them and share our resources,” said Callie Poole, a research associate on the project.

This team works to identify sources like the Center for Disease Control’s developmental sheets and Vroom tip sheets to have ready for distribution. They also make sure that the different resources are appropriate and useful for the group. Poole explains that may mean providing information for early childhood professionals working on how to talk to parents if a child is showing a delay in reaching a milestone or sharing developmental milestone trackers directly with parents at a community event. The team must know the audience they are working with and not look for a one-size-fits-all solution.

Additionally, this team has developed new documents and presentations to align with the goals of the program. They take these and the existing resources to outreach events across the state to encourage parents and community members to note developmental milestones and engage more with young children.

All of these efforts combine to enhance the early childhood developmental health knowledge and actions of families, childcare staff, and health care providers, thereby strengthening the developmental health system in Mississippi.

“If we reach all of these groups, we have a better chance of identifying developmental delays and prompting intervention for children,” said Baird-Thomas. “If we have all of these groups working together, then we will have better outcomes.”

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Visit mississippithrive.com for more information on this project.

Graphics provided by Mississippi Thrive! designer Lauren Ingram from the 2018 Mississippi Thrive! policy brief.

MARKING THE MILESTONES