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Transforming Education and Health: An Integrated System of Supports to Advance Outcomes for our Highest-Need Children and Families

The Primary School partners with parents to break down silos in education and health systems and create seamless care for children.

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Name or Organization

Our legal name is The Primary School. We partner with the Ravenswood Family Health Center, a federally qualified health center, and County of San Mateo Family Health Services to provide integrated health and family services to children and their families. We also leverage other existing community organizations and assets to build a comprehensive web of supports for families. We have a community-centric, partnership-oriented model and are engaging additional partners to launch our next sites.

Geography

Located in East Palo Alto, TPS serves underserved children and their families from the low-income, racially diverse communities of East Palo Alto and Belle Haven. Despite its location in Silicon Valley, one of the wealthiest, most technologically advanced areas in the world, East Palo Alto is a high-need community with poor population-level education and health outcomes. TPS is pursuing its next site(s) in collaboration with new partners, toward our goals of broader impact.

What is your stage of development?

  • Early Stage Innovator, with at least one-year experience in ECD

Type

  • Non - Profit

What is the stage of your proposal?

  • Piloting: I have started to implement my solution as a whole with a first set of real users.

Describe your submission in one clear sentence

The Primary School (TPS) is a comprehensive model of primary education and primary care that braids together education, health and family support services starting at birth. With this innovative new model, we aim to expand the traditional definition of “school” by supporting the needs of the whole child, including physical and mental health, and leveraging the power of parents to own this work.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

TPS is built on the premise that to achieve groundbreaking outcomes, we cannot merely tinker at the margins — we must transform the systems that serve children and families. Our model rethinks how early education, K-12 education and health care come together. Our end goal is to transform public systems through adoption of new practices, tools and policies that meet the needs of families and children. Our full-scale sites serve as innovation labs where investing in design, research, evaluation and dissemination will allow us to replicate our model and transfer our learnings to others.

Select an Innovation Target

  • System design: Solutions that target changing larger systems.

Tell us more about your innovation (1500 characters)

TPS’s fundamentally different approach is designed to dramatically improve health, educational and life outcomes for our highest-need children. Our scalable model of integrated education and primary care brings together children, parents, educators, pediatricians and family support services, starting at birth. Our guiding principles are: 1. Start early: School starts at five for most children, but research shows that much of critical brain development happens earlier in life. We therefore start our programming at birth or earlier to take advantage of this key window to impact children and parents. 2. Integrate health and education: We believe that it is critical to nurture the full well-being of the child, which encompasses not only their ability to achieve academically, but also their physical and mental health. To address “whole child” needs, we combine health and education supports in a collaborative system of care. 3. Partner with parents: We recognize that parent well-being, home environments, and parenting practice have the greatest impact on children. We work with parents to build their capacity to own their child’s health and education outcomes. Each parent receives their own coach and parent peer group that they stay with throughout their TPS experience, from birth through K-12. TPS ensures a constant flow of information with parents, staff and other providers to fully support the child as well as support the bond between parent and child.

What problem are you aiming to solve? (3 sentences)

Major systems of support for children — early education, K-12 education, and healthcare — are failing because they remain in separate silos with different policies, oversight bodies, regulations, and funding. Parents are left to navigate and coordinate each system on their own. In TPS’s model, these systems are integrated and parents are deeply engaged, for a coordinated and seamless experience for families.

Explain your idea (5000 characters)

The Primary School is not a single service or program, but an integrated system of supports and partnerships that come together to create a customized, seamless, and holistic experience for each child and family. This integrated system works together towards a single set of outcomes for children across health, education, and soul (socio-emotional) domains. Our model starts prenatally and combines health, education, and parent program elements. 1. Parent-child support: We will admit students at or before birth, and will provide parent-based, early childhood supports during the critical early years of neurodevelopment. Our early supports focus on building strong caregiver-child relationships. 2. School starting at age 3: We believe that school should start early, and that the child’s education from preschool to elementary to middle school should be a seamless, developmentally appropriate experience that builds year to year. 3. Partnership with healthcare providers: We will partner with existing health care providers to coordinate medical care for children, complemented by health promotion work that is woven into our school and family programs. Educators and health care professionals will work together to provide whole child supports for children. We also work with health partners to ensure children receive the full suite of developmental screening, and help parents manage the process of referrals to public agencies and other partners. 4. Parent coaching: Families receive continuous, group-based parent coaching (“Parent Circles”) to empower them to better support their children and become healthier themselves. Coaching is family-driven and focused on the individualized needs of every family. As needed, families receive continuous one-on-one coaching to empower them to better support their children and become healthier themselves. We also recognize that many families are facing issues that go beyond what group coaching can support, including such issues as impacts on the parent-child relationship and issues of poverty (e.g., housing, food insecurity, etc.). 5. Portfolio of partner programs and services: Our families and children are diverse and have a wide range of needs, including needs that go beyond health and education (e.g., housing, employment, food security). We seek to be a connector between families and other service providers in the community. 6. “24 hour” program: We offer health and education resources and supports that extend the reach of our in-person programs into the home through technology, activity boxes, and strategies to use at home. 7. Team-based approach to care: Each child will be supported by a team of adults from various fields that works together to support the child. This “circle” will be unique to each child and will include family members, health care providers (e.g., the child’s pediatrician), and educators (e.g., the child’s teacher). The “Child’s Circle” jointly develops, implements, and evaluates success against the child’s personalized growth plan. 8. Integrated data platform: We developed Atlas, a platform that utilizes technology to input, monitor and update plans, progress, needs, observations and issues, while enabling collaboration among providers and parents. Atlas is designed to solve the current problem of “siloed” systems of support for children (e.g., parents, teachers, pediatricians, specialists). Atlas aims to solve the problem of bringing people together to understand the full picture and solve complex needs that involve multiple people developing and executing multiple parts in a child’s consistent and comprehensive plan for change. 8. Powerful community: Overlaying all of these supports is a powerful community of parents, children, staff, and community members. Our community provides a network of supports for all its members to feel safe and access resources. Our goal is to create a game-changing system of care for children that can be adapted flexibly in other high-benefit communities to serve as proof points of what is possible when we take a more holistic approach to integrating the systems around children. To that end, we are focused on building a model that can be effectively implemented in diverse communities and can be sustained on public funding. Our comprehensive East Palo Alto site serves as a platform to understand what will work and to build tools and strategies that will scale to others.

Who benefits? (1500 characters)

TPS serves populations that mirror the diversity of the communities we serve. Since its launch in East Palo Alto in 2016, the site has grown to serve 250 infants, toddlers, children, and their families: 72% Hispanic/Latino; 11% Black/African American; 8% Native Hawaiian/Pacific Islander; and 8% Mixed/Other. The site continues to grow, with a new cohort of children added each year. We admit children via lottery but have an income cap in place for applicants as we seek only to serve low-income children. We have a strong goal of meeting the needs of children at risk for Adverse Childhood Experiences (ACEs). The numbers will grow further we expand to new sites, where children and families served will reflect their diverse communities. Beneficiaries include not only the children and families directly served, but also their communities and the sectors serving them. Our interaction with families, communities and sectors has been central since TPS’s conception and design and is ongoing at our East Palo Alto site. Our current site serves as a laboratory where we co-design and interact with parents every day and, as a result, we have deep connections with the families we serve. TPS recruits staff from the surrounding community or similar communities to ensure that staff members’ lived experiences reflect those we serve and that we remain embedded in the community through them. Our on-the-ground work with parents and families informs our program design every step of the way.

What kind of impact will your idea have? (1500 characters)

Advancing a comprehensive, integrated system of care that puts the child at the center, starting at or before birth, will prepare children to lead productive, meaningful, healthy lives. TPS is designed to generate long-lasting impact, not only for the children directly enrolled in TPS but also for driving broader systems-level impact through: 1) Sharing our work and ideas to raise awareness and influence practice, 2) Building and cross-sharing technology, tools and programs, 3) Codifying and sharing practices; and 4) Influencing local, state, and federal policy. Phase 1 (Year 1-2) of our strategy is focused on implementing the first TPS site, developing pilot tools/resources, sharing our rationale, and building awareness. As we enter Phase 2 (Year 3-5) , we will pilot/co-develop components with new partners for new sites, keeping consistent core elements of our model while advancing flexibility of components to address specific needs of each community. TPS’s in-depth evaluation and learning are critical to each phase of our growth and are used to: 1) Improve our program and model, 2) Inform strategies for growth, 3) Validate outcomes, 4) Share practices and knowledge with others, and 5) Advocate for change and inform public opinion. By 2023, we will start Phase 3, reaching more than 1,000 children (ages 0-3) and 3,000 children (ages 0-13) directly and exponentially greater numbers through broader systems change at local, state, and federal levels.

How does or how could your idea impact low-income children? (1500 characters)

Research shows: ● Family socioeconomic factors, caregiving behavior and home environment are strong predictors of developmental delays & school readiness (Zimmerman et al., 2015). ● Children develop in the context of their environment. Exposure to poverty, malnutrition, violence, abuse and neglect can lead to behavior difficulties (Cohen et al., 2005). ● Many children are impacted by trauma/Adverse Childhood Experiences (ACEs), affecting learning and health (Felitti, 1998; Harris, 2011). In short, many children start school with odds stacked against them. TPS’s 0-3 model pays close attention to factors that make it difficult for children and families to learn and be healthy. TPS engages parents to build children’s protective factors: Creating conditions for families to support their children: ● Seamless family-centered supports that build parent self-efficacy and reduces stress ● Two-generation approach that simultaneously supports parents and children ● Connection to resources (e.g. housing, food, legal services) that alleviate the realities of poverty ● A powerful community across children, parents and staff Providing parent-child supports to build child readiness for school: ● Strong connection to a full spectrum of health care, including preventive supports ● Playgroups and supports that build parent-child attachment, and socioemotional and language skills ● “24 hour school” tools that equip parents to be their child’s first teacher at home.

Innovation: What makes your concept innovative? (1500 characters)

TPS is not a single service or program, but an integrated system of supports and partnerships that come together in partnership with parents to create a personalized, seamless and holistic experience that braids together education, health, and family support services starting at birth. In doing so, TPS is expanding the traditional definition of “education” to support parents and to prepare all children to succeed throughout life. TPS’s innovation was driven by our investigations into other models and realizing the power of a new model based on central core principles: 1. Start early — admitting children (and parents and the whole family) to a school at birth 2. Integrate health and education — for a seamless and cohesive experience across education and health systems that includes access to existing resources 3. Partner with parents — by building a warm and welcoming community for and with our families that empowers parents and supports the parent-child bond.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

The primary barrier to scale is cost. We are working to make the model scalable on public funding streams that school districts and health care systems can access while ensuring quality, however the start-up costs of this model are expensive. We believe that the right program, starting at birth, will show a strong, positive ROI over the medium and long term but we will need policymakers willing to take this long view. TPS is designed as an innovation platform and laboratory, for mutual learning with partners that adopt model components and, over time, help build the will to make these investments. While working toward broader systems change, we are designing our model for scaling: 1. We leverage community assets. We create a comprehensive system of supports but create from scratch only what we cannot partner to achieve. For example, we partner with existing health care providers to build on their historical experience with families and to capture health care funding streams. 2. We utilize the power of parents. Parents are an underutilized asset in many communities. We build parent capacity to own their child’s own health and education outcomes, reducing long-term dependence on our supports. We also build strong parent-to-parent networks so parents can support one other. 3. We utilize technology for efficiency. Our product, Atlas (see above), enables us to have a broader understanding of the child and family and to communicate across teams supporting the family.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

TPS benefits from the expertise and dedication of our co-founders and staff, as well as the passionate support of our partners and community. We have a strong strategic plan and pathway to build out our work over the next 5 - 10 years. At our current East Palo Alto school site, enrollment and feedback shows TPS families are enthusiastic about their experience and their children’s progress to date, and we see a continuous stream of interest from prospective families as well as interest from current and potential partners (we receive two to three applications for every available spot in our program). We have also had interest from many other communities, nationally and even internationally, to learn from our model. We have hired staff and identified partners to help us expand to our next site. We have secured long-term financial support from our founding funder, the Chan Zuckerberg Initiative, to build and pilot the model and its technical and operational systems; however, we will still need to raise additional funding for new sites. As we grow and move into new phases, we are actively adding staff and engaging partners, such as public agencies and major health systems, to build out and support new sites and/or adopt TPS principles in their own schools and systems. Early data around parent and community acceptance and interim outcomes (both for children and parents) are promising, but we are still very much in the learning stages. We are piloting and testing, advancing our learnings and creating the building blocks to excite interest in launching sites, adopting our model, and changing systems more broadly. As we test our strategies, we will share our learnings with influencers in education and health sectors, both toward inspiring other communities to adopt similar strategies and to identify additional partners and supporters. We are particularly excited about developing and testing tools and resources that are helpful to us and that also will scale well to help practitioners adopt our model and impact more children. An example is the Atlas platform, a technology tool to support the team-based approach to care and integrated planning around a child’s holistic profile. We partnered to create Atlas to help us bring multiple stakeholders from different systems to work together and understand the full picture of a child’s needs, develop a consistent and comprehensive plan of support, and track progress on the execution of that plan. Last year, Atlas was used primarily as an internal collaboration tool. This year we are beginning to integrate external resource providers (including speech-language pathologists and occupational therapists) into the platform as well.

Business Viability: How viable is your business model? (1500 characters)

TPS conducts in-depth market research and engages experts to develop strategy for design, implementation and scaling. Our experience confirms our belief that our business model will succeed in the broader market. We have considered potential risks and barriers to scaling, such as: ● The model may be too expensive for full adoption everywhere. TPS is developing cost-effective practices, tools and resources to share with partners and communities adopting the model. ● Communities may be resistant to outside “experts” bringing in new ideas. To gain and sustain the trust of the community, TPS engages the community as ongoing partners in the work from the earliest stages of site development. ● There may be a perception that we have all the ongoing funding necessary due to our strong association with our founding funder. TPS provides updates on our progress and funding needs as we engage partners and funders to obtain secure and diverse funding to scale and sustain our sites. We will also rely on more public funding, in absolute quantity and as a percentage of costs, to support new sites. ● Ineffective adoption of our model by some partners may affect our credibility with new partners or communities. Our partnership model ensures fidelity to core program elements while allowing flexibility for community and site needs. TPS provides technical assistance and evaluation of sites, and conducts ongoing oversight of site implementation to ensure quality.

HCD: How have you used human centered design to build or refine your concept? (1500 characters)

Since September 2015, we have worked with parents in East Palo Alto on the design and implementation of our programs, conducting design sessions with community members and regularly conducting focus groups, interviews, and surveys with our population to refine our approach. A key goal is to help parents deal with life challenges and providing resources for parents to help them be resourceful to their children, therefore, we design with parents, rather than “at them.” The leadership of the Parent Advisory Group has been central to ensuring that our model benefits families. The design, launch and implementation of our model has been a team effort, with parents, community members, experts, teachers, health professionals, social workers, social service and social justice communities, partners, and others advising and contributing to this journey. We also continually learn from the families we serve. Parents are surveyed after every coaching session, given pulse surveys at pick up and drop off, and we also conduct focus groups and user interviews multiple times per year. Also, because we work so closely with families, we have extensive understanding of their lives — from their day-to-day patterns to their hopes and dreams for their children. All of these insights continue to inform our program.

Tell us more about you (3000 characters)

A growing body of research shows that trauma can seriously affect a child's health and education. Physical or emotional abuse, neglect, parental mental illness, exposure to violence or the accumulated burdens of poverty can trigger what is known as a "toxic stress" response. Despite the prevalence of toxic stress and the severity of its impact on children's lives, existing education, health, and social support systems are not set up to help the children most likely to experience trauma. TPS’s co-founders, CEO Priscilla Chan and President/COO Meredith Liu, launched The Primary School in 2016, starting with 51 preschoolers from East Palo Alto and Belle Haven, CA, to develop solutions to address toxic stress and arm our highest-need children with the skills and resilience they need to succeed. Since its launch, TPS has grown to serve 250 low-income children and their families in an integrated approach to education and health care. Priscilla’s lived experience — as a child, as a former teacher, and as a pediatrician — has informed her commitment to the TPS model. While she was growing up in Quincy, MA, her Chinese-Vietnamese immigrant family stressed the importance of school and hard work as keys to a life better than the one they left behind as refugees. Priscilla’s service as an afterschool program teacher in public housing projects in Dorchester, along with her service as a physician, led to interest in exploring solutions that combine education and health care. As she has written, “My experiences of running an afterschool program in a low-income housing project and working as a pediatrician in a safety-net hospital [have] shown me firsthand that we need a better way of caring for and educating our children…. The effects of trauma and chronic stress create an invisible burden for children that makes it very difficult for them to be healthy and live up to their academic potential. We must address these issues holistically in order to allow children to succeed.” Meredith is a deep believer in the power of education to eliminate racial inequity. Prior to co-founding The Primary School, Meredith saw first-hand the systemic education barriers in high-poverty Boston neighborhoods. Her work in Boston provided the opportunity to build stronger education systems, including when she served as a dean and then board member at Codman Academy, a Boston high school co-located with a health center in Dorchester. By bringing together health and education on our founding team, our founders represent both sides of this experience at TPS. Since the launch of TPS, Meredith and Priscilla have brought on a team that represents the expertise required in different areas, including pediatrics, early childhood education, community engagement, child development, social work, and mental health. For more detail about the inspiration behind TPS, see: http://www.cnn.com/2017/10/04/opinions/kids-toxic-stress-the-primary-school-chan-liu/index.html

Do you have the people and partners you need to do what you’ve described? (500 characters)

TPS benefits from 50 dedicated staff, including the team leading our on-the-ground work with children and parents in East Palo Alto, and our leadership, health, operations, and growth teams. We also have a Parent Advisory Group and Scientific Advisory Board to continue to support our work, as well as a broad network of community partners. To enable our work to grow and scale, we continue to seek additional partners and talented staff, as well as contacts interested in the power of our model.

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

We seek expertise, collaboration, and thought partners from the early childhood education and health spaces to help expand our knowledge base and guide our thinking. We also seek to create a platform of support for families that knits together resources and programs that are available from providers in the community, rather than building everything from scratch. As an example, we are using LENA’s Talk Read Sing, a research-based, intensive language intervention targeted at parents of children under three to help bridge the word gap, ensuring a language-rich environment at home. Talk Read Sing was developed by the San Mateo County Libraries in partnership with LENA Research Foundation. We would love to learn more about and potentially adopt solutions from the IDEO community that could be deployed as part of our portfolio of supports and resources for families. In addition, we are seeking new partners who would serve as pilot users of our program; we would welcome discussions with interested participants from the IDEO Prize innovator ecosystem.

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  • Yes, share my contact information

[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).

The mission of the Primary School (TPS) mission is to foster each child's well-being as a foundation for academic and life success by drawing on the strengths of the child's entire community including family, educators, medical and mental health providers. We envision a world in which every child, regardless of background, becomes a healthy and productive adult. For an overview and brief bios of TPS’s team, please see: https://www.theprimaryschool.org/team/
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Attachments (3)

Long term strategy 2018.pdf

The Primary School's Long Term Strategy 2018

TPS_AnnualReport.pdf

The Primary School's First Year Highlights: Annual Report 2016-17

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