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PROPEL (Promoting Reading, Optimal development, Parenting and Engagement in Local settings)

Effort to engage parents impacted by SUD in literacy supports offered in community & concrete supports related to child interaction.

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Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

NA

Name or Organization

The University of Maryland’s Institute for Innovation & Implementation at the University of Maryland School of Social Work serves as a training, technical assistance, evaluation, policy, systems design, and finance center to best meet the needs of children and youth with complex behavioral needs and their families. B'More for Healthy Babies: City Health Department, Family League, and HealthCare Access Maryland are lead agencies for BHB - develop initiatives related to prenatal and 0-3.

Geography

It is impossible to discuss the health of Baltimore City’s residents without applying the lens of health equity and systemic disparities. This reality is compounded by a series of complicated systemic social, political, economic, and environmental obstacles. With more than one in three children living below the federal poverty line and more than 30 percent of households earning less than $25,000 per year, income, poverty, and race have an enormous impact on health outcomes across the city.

What is your stage of development?

  • New Innovator, with less than one year of experience in ECD

Type

  • University

What is the stage of your proposal?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Describe your submission in one clear sentence

The collaborative effort to engage parent-young child (ages 0-3) dyads impacted by substance use disorder and/or incarceration in literacy supports to offered within community centers and libraries, as a port of entry into concrete supports related to parent-child interaction and attachment – and offer caregivers who engage in these services the opportunity to co-author the development of materials to support parent understanding and engagement with young children for their peers.

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

There is acknowledgement of the link between caregiver functioning and child well-being, yet many interventions still face significant engagement barriers for the most at-risk. Our approach, to support parents leaving SUD treatment and/or released from jail, will integrate group-based, directed child socio-emotional development coaching into community-based activities, like visiting a library or museum. This approach normalizes and reduces barriers for accessing supports, but also to improve social connections and self-efficacy among a typically isolated and disenfranchised population.

Select an Innovation Target

  • System design: Solutions that target changing larger systems.

Tell us more about your innovation (1500 characters)

This innovation utilizes literacy as a port of entry to engage this target population of high-need yet disengaged caregivers of young children in parenting supports. It is our hypothesis that caregivers of young children that are involved in the judicial and/or substance use systems are often mandated to attend parenting classes as part of their perceived treatment or punishment. These come with significant stigma and also happen without children, missing the opportunity for feedback and reflection about parent-child interactions. Through literacy interactions with reflective feedback and developmental insight into the child’s needs, we propose that parents will gain confidence in their role, serving as repair for time away due to incarceration or separation related to substance use/or recovery efforts. Once engaged, it is our plan to involve these caregivers in the development of materials to support their peers to feel confident as they reengage as parents. Focus groups will also be offered to hear more about the range of services and supports that they feel like they need most to address their needs and how they would like to receive them. We also have the evaluation capacity to conduct network analyses of the programs that are seated throughout the city to provide these services and how integrated or not they are, which can provide significant information to inform public health and public policy efforts.

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

Parents of 0-3 with SUD and/or who are re-entering post-incarceration often have competing priorities that make it difficult to engage in traditional parenting and other support services essential for establishing secure parent-child attachments. By co-locating and enhancing existing community services in a dyad-friendly, non-clinical environment, families may be more likely to begin and sustain engagement. This will focus on building a system that works together to serve needs across settings

Explain your idea (5000 characters)

Our innovation focuses on engaging caregivers addressing SUD and or recent incarceration histories within targeted and identified community settings, to offer parenting supports that focus on concrete engagement with their young children, distinct from traditional, often mandated and stigmatized parenting classes for these caregivers. Our program design looks to engage this high-need population, traditionally disconnected from public health efforts including clinic-based parenting supports and home visiting services, within community settings and libraries to engage in literacy-based parenting interactions with their children with trained staff to support the caregivers knowledge, application and confidence in interacting with their child through concrete and tangible activities. Because this innovation concept is in its early stages, we propose first to give concrete effort to fully engage community providers of services for this population, including home visiting agencies, WIC, SUD clinics, parole and judicial staff and others (often siloed and disconnected in nature) to identify which key agencies are primed to me partners and linkages for services. These provider groups and agencies will help identify and refer families in need where families go, libraries etc to design program delivery sites. We will dedicate time and expert input during this phase to further assess, beyond the literacy and developmental guidance structure for the parent support, what other evidence based practices or screeners might be indicated, including screening for Post Partum Depression, or Screening, Brief Intervention, and Referral to Treatment (SBIRT). Once partners are identified, families referred and intervention staff fully supported, we will move into the second phase of our proposal, to engage these target caregivers in system and program development through a number of targeted evaluation activities: (a) focus groups to identify needs and possible service delivery models; (b) incorporate family input on program/system designs and (c) conduct a pilot with feedback. Throughout all of this, our evaluation staff will track outcomes and engage in CQI process to document, track and evaluate to track steps/changes at the program and system level, to monitor measures and outcomes for parents and children involved in the intervention (to include SUD status, engagement in referred services, child development, parent stress, measures of parent-child interactions and parenting stress/self-efficacy). Focus groups will also be offered to hear more about the range of services and supports that they feel like they need most to address their needs and how they would like to receive them. We also have the evaluation capacity to conduct network analyses of the programs that are seated to provide these services and how integrated or not they are, which can provide significant information to inform public health and public policy efforts.

Who benefits? (1500 characters)

It is estimated that 8.3 million children (11.9%) live with a caregiver with a substance use problem (SAMHSA, 2009). Caregiver substance use impairs the ability of caregivers to fully meet the needs of young children, impacting caregiver-child relationships and child development (National Academy of Sciences, Engineering, and Medicine, 2016). Of particular concern is substance use by pregnant women and caregivers of young children. From 2000 and 2009, the incidence of Neonatal Abstinence Syndrome (NAS), and prenatal opiate use increased approximately five-fold in the U.S. with total related hospital charge increases going from $190 million to $720 million during this timeframe (SAMHSA, 2014). Living with caregivers who abuse substances is linked to a myriad of negative outcomes. Prenatal substance use exposure has especially long-lasting consequences for children. In comparison with non-exposed children from similar backgrounds, children and adolescents with prenatal substance exposure have demonstrated poorer functioning in behavior, cognition, physiological functioning, and brain development over time (Buckingham-Howes, Berger, Scaletti, & Black, 2013). Caregiver substance use impairs parenting and has been linked with inconsistent availability and interference in the development of a secure child-caregiver attachment (Hans, Bernstein, & Henson, 1999; Parolin & Simonelli, 2016).

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

When considering caregivers addressing issues of substance use – and especially for post-incarcerated, who did not have regular visits with their children during their separation, traditional clinic-based parenting groups can be stigmatizing, often prohibited by insurance if they are engaging in their own needed mental health and SUD support; and don’t address concerns related to housing stability, employment and family context. Our program design looks to engage this population, traditionally disconnected from public health efforts including clinic-based parenting supports and home visiting services, within community settings and libraries to engage in literacy-based parenting interactions with their children with trained staff to support the caregivers knowledge, application and confidence in interacting with their child through concrete and tangible activities. Literature in the fields of child development and mental health agree on the significant importance of the health of a child’s relationship with their caregivers on their developmental and educational trajectories, long-term health and employment outcomes. So impact can be multigenerational, additionally there could be a direct impact on future children that these caregivers have.

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

As a major public health issue, the consequences of substance use and addiction disproportionately affect minorities, those of lower socioeconomic status, and survivors of physical and sexual violence (Savage, 2012). Studies show that the majority of females with SUDs not only have a history of trauma, but also suffer from co-occurring mental illness (Ramaswamy & Kelly, 2015). Therefore, recovery is rarely as simple as making a choice to stop (Harris, Fallot, & Berley, 2005). Poor access to mental and physical health care complicates the trajectory of recovery for women. Some of the most concerning effects of the opioid epidemic are the increased incidence of opioid-exposed pregnancies, rapidly rising rate of female incarceration, and removal of children from families of origin. As the United States seeks to address the current drug crisis, unique opportunities present for health providers to intervene on the individual and population level (Ramaswamy & Kelly, 2015). This is particularly true as it relates to care innovations in the comprehensive treatment of SUDs in Baltimore City. Research shows parental substance use to be a factor in about 50%-79% of cases where an infant or child is removed from the parent’s custody by child welfare authorities (Grant et al, 2014). Women battling addiction are at an increased risk for homelessness, criminal justice system involvement, physical and sexual abuse, and chronic physical and mental health conditions.

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

The innovation that we are proposing is two-fold: first an effort to engage a disconnected population in support related to parenting and developmental guidance that offers concrete support to caregiver child interactions and support caregiver confidence; especially for those that are reengaging in the role. The second, and equally exciting component of this proposal looks at efforts to engage and incorporate the broad range of services, service providers and disciplines (which in its current form are handicapped by significant silos making navigation difficult for families, let alone issues of stigma and tense histories with the populations they serve in many cases). Developing this collective network, using language and approaches that are informed by the participants feedback themselves, can offer an interwoven safety net for these high-need caregivers and their young children and families; instead of spending funds to develop a new intervention, engage families in the services, and then have it go away after the close of funding.

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

This innovation is quite scalable, as it specifically intends to building upon existing systems, enhancing workforce capacity within the existing network of programs and services and working to more effectively engage families in said services. It is hard at this point to identify a specific expected number of end users, as we are intentionally targeting a group of caregivers that, despite their high-level of need of services and supports, are too often disengaged or inconsistently engaged with agency and community supports – however we are confident that targeting these caregivers with this innovative approach will have far improved responses for both caregiver engagement and child outcomes.

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

This innovation is quite scalable, as it specifically intends to building upon existing systems, enhancing workforce capacity within the existing network of programs and services and working to more effectively engage families in said services. It is hard at this point to identify a specific expected number of end users, as we are intentionally targeting a group of caregivers that, despite their high-level of need of services and supports, are too often disengaged or inconsistently engaged with agency and community supports – however we are confident that targeting these caregivers with this innovative approach will have far improved responses for both caregiver engagement and child outcomes.

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

This innovation is really focusing on public health efforts to support high-risk families, while some local foundations and businesses looking to invest in the community could potentially be pulled into ongoing sustainability and or replication efforts.

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

The concept of human centered design is at the core of our proposal. The innovation we are envisioning is about utilizing literacy as a port of entry to engage this target population of high-need yet disengaged caregivers of young children in parenting supports. It is our hypothesis that for caregivers of young children that are involved in the judicial, parole and/or substance use systems are often mandated to attend parenting classes as part of their perceived treatment or punishment. These courses come with significant stigma and also happen away from the participants children, missing out on the opportunity for feedback and reflection about parent-child interactions. We are confident that offering literacy based interaction support for caregivers and tangible interactions that can translate significantly more easily into home-based interactions between child and parent, compared to the theoretical attachment-based conversations that ground many parenting curriculum. Through supporting literacy interactions with reflective feedback and developmental insight into the child’s needs, we propose that parents will gain confidence in their role, serving to repair for time away from parenting due to incarceration or separation related to substance use/or recovery efforts. Once engaged with this offered literacy support, our plan involves this co-hort of caregivers in the development of materials and language to support their peers in understanding their child’s need.

Tell us more about you (3000 characters)

Our PIEC team collectively has a long history of working with high risk families in multiple settings. We find early childhood an inspiring time as it lays the foundation for future development, school and relationship success, and engagement in society. Both Ms. Wasserman and Dr. Candelaria have been able to transition away from direct clinical service and toward program and policy development, workforce development, and research and evaluation efforts including implementation science. In this role, our PIEC team is able to have a more widespread impact to improve services to families with young children through a variety of mechanisms. Currently, our work focuses on building systems that support families with young children through which we have seen the benefits of bringing partners together, enhancing services, creating referral networks, identifying referral sources, increasing workforce capacity, and evaluating outcomes to incorporate CQI processes. Two areas of need continually present themselves in our work – families struggling with SUD and/or re-entry post-incarceration while also in need of parenting support and their lack of ability to access multiple services in one location; and family voice in the development of design of services that are authentic and meaningful to families. SUD is at an epidemic level and for those with young children it makes parenting and supporting child development very challenging. Furthermore, those who struggle with SUDs also have a higher incidence of incarceration. Incarceration also presents a risk to the parent-child relationship and negatively impact child development due to parent-child separations and the challenges that reunification can present without support around parenting and understanding of the needs and experiences of the child. This is a population that is lacking specific attention. In attempting to address the unique needs of this population we think it is vital to design services that are informed by families themselves and are authentic in content and delivery methods.

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

PSEP (co-led by Baltimore Health Department’s Bureau of Maternal & Child Health and the city’s addiction and mental health authority) joins 30+ partners representing the spectrum of behavioral health treatment and rehabilitation programs, prenatal and pediatric providers, home visiting, and social services. HealthCare Access Maryland offers centralized care coordination for prenatal and postpartum services. We regularly work with programs that enroll moms with histories of substance use.

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)

Our innovation is focused on engagement of parents of young children with SUDs and/or recent incarceration. While we carry expertise on infant mental health and development, we lack specific knowledge of the adult serving settings such as in-patient/out-patient SUD treatment facilities or within the judicial and prison system. Targeted technical assistance with professionals with experience engaging with those systems and knowledge of programs/approaches within those systems would be beneficial to our proposed work. Additionally, opportunities to further explore the use of technology to conduct outreach and family engagement would be an ideal enhancement to our proposed work. For example, texting, social media, electronic applications or other technological applications could be incorporated in the proposed work to engage the outreach, engagement, and delivery systems.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

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

Margo Candelaria, Ph.D. Co-director, Parent Infant Early Childhood (PIEC) team at the Institute for Innovation and Implementation at the University of Maryland, overseeing research and evaluation efforts for the team. This includes system of care grants and large contracts with the Maryland State Department of Education. Kate Wasserman: https://www.linkedin.com/in/kate-wasserman-43b47387/ Jennifer Kirschner: https://www.linkedin.com/in/jennifer-h-kirschner-64230b13/

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Photo of May Aldwais
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Good idea, perfectly helpful way for parents to move forward with their kids, it is important to enhance reading and facilitate that for kids especially with the current advancement of technology.

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