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Early Childhood Systems

HRSA invests in several programs (the Early Childhood Systems portfolio) that strengthen, align, and sustain family-centered systems at the state and community levels, using the health system as a key partner. These programs focus on the prenatal-to-age-3 (P–3) period, which is a critical window of opportunity for prevention and intervention. Early childhood experiences that nurture positive health and development—starting prenatally—have lifelong impacts on health and well-being.

As a whole, programs within the portfolio support the healthy development of all children by addressing systemic barriers to coordination, reach, and equity. Programs support the needs of children and their caregivers together (known as a two-generation approach). They also promote holistic health and well-being through partnerships that bridge medical, mental and behavioral health, early care and education, child welfare, and other human services and family supports.

Shared goals across the portfolio are to:

  • Make health promotion and prevention services available to all families, as early as possible
  • Connect different sectors and providers together, to work as a team to strengthen families
  • Build services and systems that intentionally advance health equity and support families and communities to lead

HRSA’s Early Childhood Systems portfolio includes a growing number of programs that reached 36 states in Fiscal Year 2021. Program details follow.

Early Childhood Comprehensive Systems (ECCS)

HRSA has funded ECCS since 2003 to strengthen state-level leadership, coordination, and strategic improvements in early childhood systems. The program aims to build integrated maternal and early childhood systems of care that are equitable, sustainable, comprehensive, and inclusive of the health system. The current version, ECCS: Health Integration Prenatal-to-Three Program, focuses on cross-sector collaboration and partnership, health system transformation, state-level policy and fiscal innovation, family leadership, and advancing equity.

In July 2021, HRSA awarded approximately $5.1 million through 20 cooperative agreements to states and non-profit organizations under ECCS. HRSA also awarded a contract to Altarum Institute, in partnership with James Bell Associates, Change Matrix LLC, Georgetown University Center for Child and Human Development, and the Morehouse School of Medicine Center for Maternal Health Equity, to implement an Early Childhood Systems Technical Assistance and Coordination Center (ECS TACC). The TACC provides individual, group, and universal technical assistance (TA) to help ECCS recipients achieve their goals and accelerate their progress. It also advances performance measurement and continuous quality improvement for the program, collaborates across federal technical assistance centers and aligned initiatives, and provides cutting edge subject matter expertise and connectivity to best practices in early childhood systems improvement.

Infant-Toddler Court Program

The Infant-Toddler Court Program (ITCP) improves the health, safety, well-being, and development of infants, toddlers, and families in the child welfare system. HRSA currently funds a centralized, national resource center (operated by ZERO TO THREE) at $10 million per year to provide training, intensive TA, implementation support, and evaluation research for infant-toddler court teams across 28 states.

Infant-toddler court teams work at multiple levels to:

  • Provide family-centered and trauma-informed case management and support to infants, toddlers, and families in the child welfare system, with a focus on improving health and well-being,
  • Support professional development and case coordination across a range of providers, and
  • Promote system-wide improvements to improve service access, strengthen families, and reduce the occurrence or impact of child maltreatment.

HRSA expects to make new awards under the ITCP for a National Resource Center (see HRSA-22-074 Notice of Funding Opportunity) and multiple State Awards (see HRSA-22-073 Notice of Funding Opportunity) in Fiscal Year 2022.

Early Childhood Developmental Health System (ECDHS)

The ECDHS program strengthens state-level systems of comprehensive early developmental promotion, screening, and interventions, with a focus on reducing disparities in early developmental health and family well-being in areas with high levels of childhood poverty. HRSA awarded $3.5 million per year to the University of Mississippi Medical Center under ECDHS: Implementation in a High Need State (PDF - 850 KB).

HRSA expects to award the ECDHS: Evidence to Impact program in Fiscal Year 2022. This iteration will support the implementation and evaluation of systems-building interventions, advance critical infrastructure and policies, and enhance the early childhood workforce (see HRSA-22-091 Notice of Funding Opportunity).

Rural Health Integration Models for Parents and Children to Thrive (IMPACT) Program

Rural Health IMPACT improves the health and well-being of young rural children and their families, particularly those impacted by prenatal substance use and Neonatal Abstinence Syndrome, by ensuring access to critical support services. The program focuses on building a continuum of care that supports early identification of and intervention for family health and economic needs in rural settings, using evidence-based, two-generational strategies. HRSA currently funds the West Virginia University Research Corporation at $600,000 per year to provide training, direct support, and tailored resources to health providers and parents, as well as implement and evaluate family service navigation and cross-sector service connections in three demonstration sites.

Contact Us

Dina Lieser
Early Childhood Systems Programs Director and Team Lead

Natalie Surfus
Public Health Analyst; ECCS and ECDHS contact

Lynlee Tanner Stapleton
Early Childhood Policy and Technical Assistance Analyst; ITCP contact

Ekaterina Zoubak
Social Science Analyst; ECCS and Rural Health IMPACT contact

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