On July 1, 2021, the Wisconsin Department of Health Services (DHS) awarded $1.2 million in grants to 15 local county Birth to 3 programs across the state to pilot new and innovative efforts to improve outcomes for participating children. These grants allowed local areas to explore new and better ways to address the unique needs of children with developmental delays and disabilities. Some aimed to increase coordination between different partners trying to help the children. Some offered new trainings for staff and families. Some tried out new tools to help identify children’s issues early and trigger action. Some programs tried combinations of these approaches. All are based on a common understanding: early interventions can change the trajectory of a child’s future.
The Institute for Child and Family Well-being (ICFW) from the University of Wisconsin-Milwaukee created this report, which contains their key findings and policy recommendations.
DHS awarded 15 Innovation in Social-Emotional Development grants. Abstracts and recorded presentations from the grantees are below.
Circle of Security
Description not submitted
Jackson County completed the 2020 Birth to 3 social-emotional grant by completing Circle of Security, Reflective Supervision, Ages & Stages training, and Resilience and Trauma training.
Circle of Security Intervention provides intensive therapy to caregivers using the Circle of Security Intervention Protocol. In order to build the child’s secure attachment to caregivers, this intervention focuses on helping caregivers understand their child’s cues and miscues, and to better manage not only their child’s behavior but also the child’s feelings. Circle of Security helps caregivers assist their child in development of better abilities in the areas of self-soothing, self-control and the repair of day-to-day relationship upsets. This protocol is used worldwide to help children increase happiness, more responsive, and be more cooperative with their caregivers.
Reflective Supervision Learning Collaborative is a year-long professional development opportunity for infant/early childhood supervisors who would like to learn how to implement and provide reflective supervision within their programs while simultaneously receiving reflective consultation themselves.
Ages & Stages Questionnaire is a trusted screener that unlocks critical knowledge about young children’s development and helps to give children the best start in life and strengthen work with children and families.
Resilience training can improve resiliency for self, community, and families and enhance quality of life. It can also decrease stress and anxiety by teaching people to view life's inevitable challenges as opportunities.
Our project applied three separate interventions with the goal of increasing infant and toddler social-emotional development for children in La Crosse and Vernon Counties. In the first initiative, La Crosse County engaged in exploration and initial implementation stage work for a Safe Babies Court Team. This links Birth to 3 Program services with other systems in the county to improve outcomes and prevent future court involvement in the lives of very young children. As a result, Safe Babies Court embraced families with a team approach and provided targeted and timely services. The second initiative provided an intensive Circle of Security Certification track for Birth to 3 Program staff who embedded Circle of Security practices within regular Birth to 3 services with a small cohort families. Mindful of a systems approach to implementing good practices, the full Birth to 3 team, supervisors, county Birth to 3 lead, and Child Protective Services (CPS) social workers completed a one- or four-day training to increase fluency in Circle terminology so that these staff could support implementation with families. The third initiative funded Infant Mental Health (IMH) Certification training for a service coordinator. This certification resulted in enhanced program readiness to apply robust social-emotional assessment practices to our evaluation work and provided an infant mental health perspective on our team. The service coordinator who completed this program stepped into a program vacancy after the retirement of our seven-year part-time infant mental health specialist; thus ensuring that our program has a primary coach on our team who can provide the IMH perspective. A longer time-frame and intensified implementation strategies are needed to assess the long-range sustainability and actual impact of these efforts.
The Wood County Birth to 3 Program's project focused on the improvement of enrolled infants and toddlers social and emotional development to help reach the state target of at least 60% of infants and toddlers showing greater than expected gains in social and emotional development. To meet this goal, Wood County looked at improving challenges within the program for both service providers and enrolled families by addressing a lack of theoretical tools available to service providers and increasing limited opportunities to children and families for social-emotional growth. Grant funds were used to:
- Purchase regulatory and educational materials for immediate demonstration and distribution purposes (for example, weighted vests, chews, therapy brushes, books)
- Provide training relevant to social-emotional health (for example, Circle of Security, infant massage, music therapy)
- Provide a monthly activity bag to all enrolled children (for example, book and activity)
In looking at our recent data, it is showing that we met our goal and state target of at least 60% of infants and toddlers showing greater than expected gains in social and emotional development. All team members will continue to implement the knowledge and skills they developed through the different trainings and through the partnership with Music Therapy Services of Central Wisconsin LLC and Interlocking Autism Therapy LLC with new families ongoing. The monthly activity bags will hopefully be able to be continued through either donations or the team being creative in coming up with free activities using recycled products.
Devereaux Early Childhood Assessment (DECA)
The Barron County Birth to 3 Program proposed a three-goal initiative with the support of grant funds to build on the capacity of its early intervention team to enhance families’ positive social-emotional skills. The intervention team, newly assembled on July 1, 2019, was motivated to provide input and participate in the initiative to gain knowledge, tools, and guided practice to support the complex needs of children and families who are referred to the Birth to Three Program through Child Abuse Prevention and Treatment Act (CAPTA) referrals or otherwise identified to have concerns in social or emotional development.
The team needed additional time and outside support to provide training and practice sessions, funding to purchase the tools and materials for implementation, and higher level support to build leadership with reflective supervision and consultation opportunities. Through these activities, time was provided to work through new practices and offer opportunity for ongoing support and review during this time of learning. We built the capacity of the staff leading our team meetings to guide team members through the challenges that arise in working with children and their families by providing additional training in reflective supervision. Carryover was seen in the practices used to support families by the primary coaches and service coordinators.
With the onset of the COVID-19 pandemic, staff turnover, and decreased contact with the community, limitations unanticipated at the start of this initiative were identified in the proposed goals. Despite the unforeseen obstacles, positive results were realized and identified as sustainable practices. With the shift from in-person to virtual training, additional staff from the child protection unit were able to be included in this initiative.
Chippewa and Eau Claire counties decided to pursue a consortium social-emotional grant for several reasons; not only are they close in physical proximity of each other as neighboring counties, they also contract with the same agencies for their Birth to 3 programs (CESA 10 and HSHS St. Joseph’s Hospital/Prevea). In a June 2019 report out of UW–Madison’s Institute for Research on Poverty, the two counties were identified in the top three counties in the state for highest poverty rates and have experienced a significant increase in child abuse cases involving methamphetamine. Because extreme poverty and ruptured relationships are contributors to toxic stress and are leading causes for social-emotional and mental health concerns if these are not addressed, the counties chose to pursue implementation of the DECA-I/T, Devereux Adult Resilience Scale (DARS), and Your Journey Together Curriculum (YJT). The evidence-based curriculum expands knowledge and skills of staff so they can more effectively assess and promote social emotional development in children.
Goals: The goals of the grant were as follows:
- Team members will be trained to administer the e-DECA I/T and DARS
- Team members will be trained in the Your Journey Together curriculum
- Team members will actively use the Your Journey Together curriculum with at least 75% of children enrolled in the Birth to 3 Program.
Achievement of these goals will promote the following objectives for each team member:
- Learn how to administer, score, and explain results of e-DECA I/T
- Explain the importance of children’s early experiences
- Define resilience and protective factors;
- Identify and use measurement tools to help families promote resilience
- Describe protective factors that promote resilience
- Learn techniques for coaching parents through Your Journey Together lessons
- Learn how to select and use research-based strategies with parents to build resilience
Sauk County’s Innovation in Social-Emotional Development Birth to 3 grant participants established the following goal: “Children enrolled in Sauk County’s Birth to Three program will make gains in social-emotional development as measured by an increase in protective factors.” Grant monies were used to provide Growing Great Kids evidence-based certification parenting training for 25 home visitors and program supervisors from a variety of Sauk County home visiting programs. The Growing Great Kids Socialization program was also purchased for three additional staff to be trained to facilitate parenting groups that focus on social-emotional development. Additional funding was utilized to purchase supplies for Growing Great Kids implementation and supplies for the Birth to Three Program’s “Popsicles in the Park” socialization events that were offered during the summer of 2021. Grant activities have also included community outreach and other activities that support early childhood mental health. Due to the pandemic, implementation of full grant activities experienced significant delay. Preliminary results of grant activities indicate that home visiting staff have increased their confidence in providing social-emotional development strategies and are practicing ways to utilize Growing Great Kids tools in each of their identified programs. Families served indicate that the information is understood and enjoyable. Home visitors and supervisors are continuing to meet on a monthly basis to support Growing Great Kids implementation and to provide case consultation in a collaborative and reflective format.
The Waukesha County Birth to 3 Program, in collaboration with Birth to 3 provider Lutheran Social Services of Wisconsin and Upper Michigan, Inc. (LSS), proposed to positively impact the social-emotional development of children enrolled in the Birth to 3 Program through a process of organizational change to be realized in the following ways:
- Development of coordinated services resulting in greater identification of children’s needs
- Improved family engagement, and a multi-system focus on social emotional development
- An increase in overall staff competency through coordinated training and certification efforts
- Development and implementation of organizational practices to support multisystem collaboration.
What we envisioned was a comprehensive and seamless service delivery system designed to improve the engagement and experience of our most vulnerable children and families. Grant activities and results included:
- Introduction of Ages & Stages Questionnaires®: Social-Emotional (ASQ:SE) — administered to all referrals
- Scheduling of a four-day Circles of Security training to be held in 2022 for LSS Birth to 3 staff and Health and Human Services (HHS) staff and ongoing consultation provided by Brave Spaces
- A social-emotional goal was added to the Individualized Family Service Plan (IFSP) to be used when appropriate
- A new referral form was developed for CPS staff to use when referring to Birth to 3
- In consultation with Waukesha County, a new process was developed whereby at initial assessment, county workers would endeavor to obtain written consent to screen for Birth to 3 services.
We feel that the above referenced innovations are sustainable, scalable, and replicable and have the potential to enhance Birth to 3 services statewide.
Parents Interacting With Infants (PIWI)
One of the primary goals of early intervention is to enhance a caregiver’s capacity to understand and be responsive to their child’s developmental needs. This is especially important in families who have experienced trauma. Through this grant, the Fond du Lac County Birth to 3 Program, in partnership with the Fond du Lac County Department of Social Services (DSS), worked to create additional opportunities for supporting positive parent-child interaction. One of the underlying themes of the Fond du Lac County grant work was to share knowledge and build relationships among team members from both Birth to 3 and DSS through shared ownership and responsibility for shared families. Group meetings and trainings, although stifled by the pandemic, helped to create opportunities for team-building. Additionally, Birth to 3 interventionists and DSS workers were trained together in order to ensure that all team members possessed a shared understanding and language around the topic of social emotional development. This began with training and practice with the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) assessment tool. Team members also received training in the Parents Interacting With Infants (PIWI) model. A joint training, developed by Birth to 3 staff, was completed to support using books to promote interaction and build social emotional connection between a caregiver and child. The result of training and collaboration was shared resources and opportunities for support to families. Resources included children’s books that were available in both departments to share with families, and the culminating opportunity was a series of collaboratively facilitated PIWI parent groups. Although only one series of PIWI groups was completed during the grant period due to pandemic restrictions, the grant helped the team develop the skills needed to facilitate groups and to obtain the necessary materials for future groups. These skills and materials were also purposed for creating more positive environments for families needing supervised visitation through DSS. The end result of the grant work is a shared vision and commitment to continued investment of time and resources for collaborative support to Fond du Lac County families.
The Kenosha County Division of Children and Family Services and Kenosha Achievement Center utilized funds to expand resources for families to improve social-emotional (SE) outcomes for children enrolled in the Birth to 3 Program. Primary project activities included:
- Expansion of Parent Child Interaction Therapy (PCIT) services
- Creation of a Parent University (Parent U) with professionally recorded videos grounded in the principles of positive parenting
- Staff training.
Program goals were to:
- Increase the percentage of children who demonstrate increased positive SE skills
- Improve parental knowledge and ability
- Reduce screen-ins for child abuse and neglect
The project was successful in training staff and expanding PCIT. It also successfully developed 12 micro videos and Developmental Take Home kits, and boosted the Bright by Text app. A total of 56 families participated in Parent U, of which 86% successfully completed. The majority of families, 96%, did not have a new incident of child abuse and neglect, and 87% reported increased understanding of SE development. Over half of children with low SE scores at intake, 58%, improved functioning to a level near to same-aged peers or comparable, and all 12 children enrolled in PCIT successfully decreased externalization and disruptive behaviors. The most valuable sustainable resource was staff training. The PCIT train-the-trainer continues to increase play-group capacity, and staff were successfully trained in SE documentation, Mindfulness, and Autism Spectrum Disorder. Curriculums were established and will continue to be offered, along with the 12 recorded videos and Bright by Text app.
Goal of the innovation
To improve social-emotional outcomes for enrolled children by implementing evidence-based practices and system changes.
- Enhancing the impact on children's social-emotional development through the addition of the Devereux Early Childhood Assessment for Infants/Toddlers (DECA) to the assessment process.
- Building the capacity of the families to care for their child and reduce likelihood of child abuse by implementing Triple P Primary Care.
- Expanding screening activities and increasing the child find process in our county by providing Ages and Stages Questionnaire-3 (ASQ-3) and Ages and Stages Questionnaire Social Emotional-2 (ASQ:SE-2) to our community partners who have established relationships with the families they are serving.
Results of grant
- The original core grant team of 20 consisted of Polk County Community Services Division and St. Croix Chippewa Indians of Wisconsin Services staff. The team was reduced to 10 due to staffing changes caused by the pandemic. The core team was then supplemented by members of the Polk County Social and Emotional Home Visiting Coalition who provide parent and early childhood education.
- The planned ongoing mentoring and coaching of team members using reflective supervision practices was eliminated due to no availability of behavioral health services in our community caused by pandemic staffing changes. However, The Polk County Social and Emotional Home Visiting Coalition was created to offer continued support to grant team members.
- The grant has improved the competency and confidence of the core grant team in assessing social-emotional development, improving children’s social-emotional development, and increasing parenting skills.
Recommendations for sustainability or expansion
Create a local Home Visiting Coalition. The Polk County Social and Emotional Home Visiting Coalition was created to offer resources, education, support, and problem solving to the grant team members. As a group it was determined the focus should be on home visitors who service families with children under the age of 3 and are residents within Polk County. The coalition continues to meet monthly with no outside funding.
The goal of this grant was to increase confidence and competence of Birth to 3 staff, CPS, and caregivers, reducing the number of families directly involved in CPS service.
Two staff from CPS and Birth to 3 obtained their Mental Health Certificate. These staff worked together to better understand the strengths and opportunities between Birth to 3 and CPS within the county. As a result of this collaboration, CPS made referrals to Birth to 3 prior to the formal CAPTA referral which allowed for immediate support to families in need. A folder, referral form, and brochure were created for staff and families.
The Body Keeps the Score book club was offered to all CPS and Birth to 3 staff to build team capacity and knowledge regarding trauma and regulation.
A family friendly visitation area was upgraded to enhance parent-child relationship and support parent aids in facilitating the parent-child relationship.
Due to COVID-19, PIWI was replaced with a Parent/Child Dyadic Group with emphasis on caregiver responsiveness and engagement.
Birth to 3 staff were given a tool (Feeling Survey) to increase awareness of parent/child regulation.
Birth to 3 staff were trained in emotion coaching and special play.
Peaceful Parent - Happy Kids training was developed and will be offered in the Spring of 2022.
Birth to 3 staff attended the Infant Mental Health Conference to increase confidence, competency, sense of being connected and understood, and reflective capacity. Staff increased knowledge in common practice.
Unique and Impactful Innovation Strategies
The Brazelton’s Touchpoints Approach was integrated into service delivery for Dodge and Jefferson counties. Use of Touchpoints is proven to enhance caregivers’ ability to successfully navigate the natural burst and regression of development or Touchpoints. When supported through the disruptions that Touchpoints can cause in a family system, the caregiver can navigate these challenges in a nurturing way. This fosters the positive early relationships that promote healthy social and emotional development.
Program supervisors became certified as Touchpoints facilitators in April of 2021. The supervisors then facilitated two trainings. County Birth to 3 providers, alongside child welfare staff, were trained in September. Another training was offered to community partners in November. To support implementation of Touchpoints, trainees attended monthly reflective calls.
As a result of grant activities, 25 Birth to 3 providers and 11 community partners are implementing Touchpoints in their work with children and families. Providers report an increase in their competencies in Touchpoints and their ability to implement it into their work. Family survey data shows an increase in caregivers’ confidence and competence in promoting their child’s development since implementation. Caregivers also report an increase in the quality of their interactions with their child.
The Birth to 3 teams have found that the Primary Coach Approach to Teaming supports sustainability of the Touchpoints approach across programming. To further support expansion, the supervisors joined the Wisconsin Child Welfare Professional Development System network of Touchpoint trainers. They will continue to be the liaisons for future Birth to 3 and community trainings.
Milwaukee County Birth to 3 Program was awarded the Birth to Three Innovation in Social-Emotional Grant with the goal to increase the accessibility and inclusivity of Birth to 3 services in relation to social-emotional health and increase the number of children achieving greater than expected gains within the program. This allowed for the creation of opportunities to better educate, reach, and serve our families and staff. Grant activities included:
- A multimedia outreach campaign
- Staff professional development including the Facilitating Attuned Interactions (FAN), Healing Focused Care (HFC) Approach, social-emotional screening and evaluation utilizing the Ages and Stages Questionnaire (ASQ-SE2), the Social-Emotional Evaluation Assessment Measure (SEAM)
- Parent classes were also offered through The Parenting Network such as one-time Triple P Seminars or 10-week Nurturing Parenting Classes
The multimedia outreach campaign helped increase the awareness and importance of early intervention during the COVID-19 pandemic. Creation of an online referral platform was created due to families being in isolation, subsequently we observed an increase by 35% in social-emotional referrals. We then directed our efforts to meet families virtually by launching a Facebook page, creating YouTube videos, and Google advertisements. Despite the pandemic, we attained 38% enrollment rate in 2021 (pre-pandemic 38% 2017). FAN and ASQ-SE2 made the most impact with our staff and families, allowing both to connect, increasing dialogue about social-emotional development.
The implementation of the grant also created the Social-Emotional Grant Workgroup, a group of Birth to 3 professionals deliberating sustain talk for FAN and ASQ-SE2 and continued discussions of social-emotional development.
Pierce County and our partners leveraged this funding opportunity to make system-wide changes to support the social-emotional needs of vulnerable families. This project aimed to increase the social-emotional wellbeing of children enrolled in Birth to 3 by achieving the following goals:
- Improving mental health, knowledge, and responsiveness among parents
- Improving system responsiveness to the social-emotional needs of Birth to 3 families; especially identified as high-risk through Child Protective Services (CPS) involvement
- Improving our system’s ability to identify and refer children with social-emotional needs to Birth to 3
The project piloted parental depression screenings among parents of children enrolled in Birth to 3, followed by referrals to appropriate resources to increase parents' capacity to support their child's social-emotional development. Screenings were challenging to integrate into the program, but it was helpful to have resources available related to parental health when indicated. The project also supported the development of protective factors and parent responsiveness by providing training designed to equip system stakeholders with the tools and shared language necessary to serve families involved in Birth to 3 and CPS. This included Triple P training for Birth to 3 and Family Resource Center (FRCSCV) staff and Parents as Teachers training for CPS staff. Due to the COVID-19 pandemic, implementation was stymied, but early input from staff has been positive. Pierce County Public Health Department (PCPHD) partnered with CPS to improve information-sharing, referral, and case coordination processes to ensure the system is responsive to our most high-risk families. Process changes have improved staff satisfaction with the referral process.