Community partnerships are measuring positive results in giving at-risk kids a better start in life
By Lisette Hilton
Illustration by Ann Cutting
ealth challenges can take hold early in a child’s life, often in the form of developmental differences. Major differences in reading and math ability can start before kindergarten, and these early-life developmental disparities often follow children into adulthood, affecting adult morbidity and mortality.
“The Robert Wood Johnson Foundation did a large study looking at the top 10 things we could do to improve the health of all Americans,” said Jeffrey P. Brosco M.D., Ph.D., associate director of the Mailman Center for Child Development and professor of pediatrics at the Miller School. “A lot of things you could predict — healthy environments, reducing smoking, better diets. But number one was improving early childhood development.”
Childhood development happens in the community — where children and families live, go to school and play — not inside an academic institution, according to Dr. Brosco, so, in 2013, the Mailman Center changed what he calls “old school” thinking about how improve child development in communities.
Instead it began to focus on interprofessional collaborations — about 100 faculty from 20 Miller School and University of Miami departments are currently involved — and deepening relationships with the economically challenged communities of Overtown, a historically Black community, and East Little Havana, known for its largely immigrant Hispanic population. The goal was to make real and sustained population-level impacts. Today, leaders of the two communities are members of the Mailman Center’s faculty, and Mailman Center faculty sit on the community partners’ boards and committees.
“We’ve really integrated dramatically over the last decade,” said Dr. Brosco, who also is associate chair of population health at the Miller School, a new role charged with looking at how health care policy and health care systems impact the health of children, not just in the hospital but also in the community.
This community-academic commitment to collaborate, listen, learn and act has translated to measurable improvements in children’s development.
In one study published this year, the authors reported on changes in key indicators of child well-being in East Little Havana and Overtown since these communities began their partnerships with the Mailman Center.
The study authors, which include Miller School researchers and students as well as community leaders, found high school graduation rates and kindergarten readiness rose dramatically from 2011 to 2017 in the community-academic partnership communities, compared to socioeconomically similar comparison communities.
Scientific thinking — a measure of kindergarten readiness — improved by more than 400% in Overtown, while it worsened by about 22% in comparison communities. Mathematical thinking improved by about 363% in Overtown, while it too declined in the comparison communities.
“One of the things we have found in our work with community partners is there is a huge disparity in school readiness across race and ethnicity.”
High school graduation rates improved during the study period by more than 21% in Overtown and 25% in East Little Havana, compared to a 2% decline in comparison communities.
“As an organization, we’ve shifted how we operate and think about research, training, services and even policy work,” said study author Douglene Jackson, Ph.D., assistant professor of pediatrics, associate director of community engagement at the Mailman Center, and leader of the Healthy and Safe committee at Overtown Children and Youth Coalition. “Community-academic partnerships create opportunities to further what we do here at the Mailman Center, especially at the neighborhood level, as we continue to deepen our community relationships, engage authentically with stakeholders and have a selective impact with the aim to improve collaboration services and overall well-being.”
Among the many other projects within the partnership are those focused on co-creating interventions that promote community health and equity within early childhood systems, noted Ruby Natale, Ph.D., Psy.D., associate professor of pediatrics and a pediatric community health psychologist at the Mailman Center.
Dr. Natale and her colleagues are working with all 1,500 child care centers in Miami-Dade County on such projects as Healthy Caregivers-Healthy Children, an obesity-prevention intervention featuring a tool kit for child care centers that serve children ages 2 to 5 years.
“The aim was to take children off the trajectory of becoming overweight. When you talk about 2- to 5-year-olds, you don’t want these children to lose weight. You just want to take them off that trajectory of becoming overweight,” Dr. Natale said. “The project has morphed over the years, and for that I credit our community partners, because they helped us identify gaps and needs in the area.”
In a randomized controlled trial published last year, Dr. Natale and coauthors found that the body mass index in children in child care centers that had the intervention leveled off two years post-intervention, while it continued to increase in children in preschools without the intervention.
The community-academic partnership is also focusing efforts on children with special needs.
“One of the things we have found in our work with community partners is there is a huge disparity in school readiness across race and ethnicity,” said Michelle Schladant, Ph.D., assistant professor of pediatrics and assistant director of the Mailman Center. “But these disparities are even greater for young children with disabilities who have culturally and linguistically diverse backgrounds. We also know that early literacy is critical to kindergarten readiness, and young children with disabilities lag far behind.”
Assistive technology in the classroom can help close the gap, but the technologies are underused. As a result, an interdisciplinary group of Miller School researchers is working closely with the community partners to develop and pilot an integrated online professional development program, called StepupAT, for preschool teachers to help them adopt evidence-based assistive technology practices aimed at supporting early literacy skills in young children with disabilities.
Planned relationships with an area in Little Haiti and with the Tribal Nations will build on the existing community partnerships, according to Daniel Armstrong, Ph.D., director of the Mailman Center.
“Working with our partners in the communities is crucial to making the kind of major difference that needs to happen to address the health inequities,” he said.