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Early Childhood Systems

HRSA’s Early Childhood Systems portfolio aims to strengthen, align, and sustain multigenerational systems at the state and community level, with a focus on engaging and connecting the health system. It focuses 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.

Collectively, programs within the portfolio support the healthy development of all children within their states and communities by addressing systemic barriers in coordination and reach, and building and sustaining equitable systems of care that are family-centered, multigenerational, and culturally competent. Programs also support the needs of parents and caregivers, using holistic, two-generational approaches.

Goals for the portfolio include supporting state, community, and family leaders to provide comprehensive, coordinated, and equitable services for families; promoting early developmental screening and service linkage; expanding the usage of sustainable best practices among providers; and supporting organized and purposeful partnerships with a focus on equity and community involvement.

HRSA’s early childhood systems portfolio supports a growing number of programs with reach in many states, communities, and tribal entities. Programs include:

  • Early Childhood Comprehensive Systems (ECCS) Program,
  • Early Childhood Developmental Health System (ECDHS) Program,
  • Rural Health Integration Models for Parents and Children Together (IMPACT) Program, and
  • Infant-Toddler Court Program (ITCP).

Early Childhood Comprehensive Systems (ECCS)

ECCS: Health Integration Prenatal-to-Three Program (2021-2026)

In July 2021, HRSA awarded approximately $5.1 million through 20 cooperative agreements to states and non-profit organizations to support the ECCS: Health Integration Prenatal-to-Three Program. The purpose of this iteration of ECCS is to build integrated maternal and early childhood systems of care that are equitable, sustainable, comprehensive, and inclusive of the health system, and that promote early developmental health and family well-being and increase family-centered access to care and engagement of the prenatal-to-3 (P-3) population. A maternal and early childhood system of care brings together health, early care and education, child welfare, and other human services and family support program partners—as well as community leaders, families, and other stakeholders—to achieve agreed-upon goals for thriving children and families.

A new Early Childhood Systems Technical Assistance and Coordination Center (ECS TACC) will support ECCS recipients to achieve their project goals and accelerate their progress. The TACC will also support performance measurement and continuous quality improvement for the program, collaborate across federal technical assistance centers and aligned initiatives, and provide cutting edge subject matter expertise and connectivity to best practices and policy and funding opportunities. HRSA has 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 the ECS TACC.

The goals for the ECCS program are to:

  • Increase state-level infrastructure and capacity to develop and/or strengthen statewide maternal and early childhood systems of care;
  • Increase coordination and alignment between maternal and child health and other statewide systems that impact young children and families to advance a common vision for early developmental health and family well-being;
  • Increase the capacity of health systems to deliver and effectively connect families to a continuum of services that promote early developmental health and family well-being, beginning prenatally;
  • Identify and implement policy and financing strategies that support the funding and sustainability of multigenerational, preventive services and systems for the P-3 population; and
  • Increase state-level capacity to advance equitable and improved access to services for underserved P-3 populations.

ECCS efforts aim to increase statewide access to integrated, effective, culturally appropriate, evidence-based early developmental health and family well-being promotion, prevention, and early intervention practices and services during the prenatal and early childhood period. Earlier family engagement in high-quality comprehensive services supports long-term family protective factors, reductions in risks to health and development, and improvements in indicators of health and well-being.

ECCS Impact Grant Program (2016-2021)

Using a Collaborative Innovation and Improvement Network (CoIIN) approach, the ECCS Impact grant program works to enhance early childhood (EC) systems building and demonstrate improved outcomes in population-based children’s developmental health and family well-being indicators.

Additionally, these grants develop collective impact expertise and implement and sustain efforts at the state, county and community levels.

How It Works

Grant recipients identified up to five place-based communities within their state or territory to participate in the Early Childhood Comprehensive Systems Collaborative Innovation and Improvement Network (ECCS CoIIN). At least one of the identified communities in each state receives state and/or tribal Maternal, Infant and Early Childhood Home Visiting (MIECHV) services.

Measuring Success

Within 60 months of the program's start, the program’s primary aim is for participating communities to show a 25% increase in age-appropriate developmental skills among their communities’ three (3) year old children.

Secondary aims include:

  • strengthening leadership and expertise in continuous quality improvement (CQI);
  • achieving greater collective impact in early childhood systems at the state, county, and community level;
  • developing primarily two-generation approaches to drive integration of early childhood services vertically and horizontally;
  • developing and adopting core sets of indicators to measure Early Childhood (EC) system processes and outcome indicators to measure population impact around children’s developmental health and family well-being; and
  • testing innovative EC systems change ideas, developing spread strategies and adopting new EC policies for sustaining the systems.

ECCS CoIIN Coordination Center

The Early Childhood Comprehensive Systems Collaborative Innovation and Improvement Network Coordination Center (ECCS CoIIN CC) manages, coordinates, and executes the CoIIN process with the ECCS Impact recipients and communities and guides and facilitates three successive 18-month CoIIN cohorts of one to five place-based communities per participating ECCS Impact grantee.

To improve results for families, the ECCS CoIIN CC uses the following approaches:

  • collaborative learning,
  • identification of core indicators/benchmarks,
  • implementation of coordinated strategies,
  • rapid tests of change, and
  • real-time date and collective impact principles.

The ECCS CoIIN CC will provide intensive, targeted assistance to the ECCS Impact recipients in providing support to their identified place-based communities.


In July 2016, HRSA awarded 12 ECCS Impact grant recipients and one recipient of the ECCS CoIIN CC. The project period for both grants is 5 years (August 1, 2016-July 31, 2021).

Grant Name Award Amount Recipients
Early Childhood Comprehensive Systems Impact (ECCS Impact) Up to $426,600 per year, per grantee

10 state agencies: Alaska, Delaware, Hawaii, Indiana, Louisiana, Kansas, Massachusetts, New Jersey, New York and Utah; 2 organizations: Florida and Oklahoma.

Early Childhood Comprehensive Systems Collaborative Innovation and Improvement Network Coordination Center (ECCS CoIIN CC) Up to $1.1 million per year The National Institute for Children’s Health Quality, Inc., Boston, MA

For more information, view the Early Childhood Comprehensive Systems IMPACT Program (PDF - 172 KB).

Early Childhood Developmental Health System: Implementation in a High Need State

On September 18, 2017, HRSA awarded $3.5 million to the University of Mississippi Medical Center to support the Early Childhood Developmental Health System Program. This funding aims to improve population level early childhood developmental health outcomes in a state with significant risk factors for poor child health status. Major activities include the implementation of a high quality statewide early childhood developmental health system, the development and utilization of an early childhood cross-systems workforce program, and an evaluative study on best practices, polices and innovations that can serve as a model for other states with high needs.

For more information, view the Early Childhood Developmental Health System: Implementation in a High Need State Program (PDF - 318 KB)

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

HRSA has awarded $600K to West Virginia University Research Corporation through the Rural Health Integration Models for Parents and Children to Thrive (IMPACT) program. The funding will implement evidence-based, two-generational strategies that promote health and well-being of young rural children and create economic opportunities for their families through supporting implementation sites and providing technical assistance around:

  • ensuring rural children and their families have access to critical health, development, education, and family support services that are aligned and coordinated;
  • improving early identification of and intervention for high-risk families who have experienced or are at-risk for adverse childhood experiences, maternal depression and other mental health issues, substance use disorders including opioid use and related neonatal abstinence syndrome, as well as other factors that lead to poor health and social outcomes for rural families; and
  • developing, implementing, and expanding two-generational strategies that effectively link children and their families to services to encourage: a) children’s healthy development; and b) help families overcome barriers to achieving economic security and self-sufficiency.

The Rural Health IMPACT program will build on lessons learned from the initial Rural IMPACT demonstration, including providing direct support and tailored technical assistance to communities. The program prioritizes and facilitates the coordination of programs and services needed to address the additive effects of poverty and geographic isolation on early childhood health and development. Performance measures will align with HRSA’s Maternal, Infant, and Early Childhood Home Visiting program.

For more information, view the Rural Health Integration Models for Parents and Children to Thrive (IMPACT) Program (PDF - 174 KB).

Infant-Toddler Court Program

The Infant-Toddler Court Program grant was awarded to Zero to Three in September 2018 at $3 million dollars per year for three years pending funding availability. The overall goal of the Infant-Toddler Court Program is to improve the health, safety, well-being, and development of infants, toddlers, and families in the child welfare system. The program will support the implementation and quality improvement of infant-toddler court teams.

Infant-toddler court teams provide case management and family support to infants and toddlers in the child welfare system and work to strengthen and align the child welfare, health, and early childhood and community systems to strengthen the health and well-being of infants and toddlers and their families.

The Infant-Toddler Court Program will provide training, technical assistance (TA), implementation support, and evaluation research for infant-toddler court teams. Ten implementation sites will be directly supported. Each implementation site will serve as the backbone organization in the community implementing the infant-toddler court model.

The program will also:

  • Promote the spread of evidence-based infant-toddler courts to other jurisdictions
  • Build the evidence-base for infant-toddler courts
  • Promote the implementation of two-generation, trauma-informed, evidence-based early interventions in the court and child welfare systems and across child- and family-serving systems
  • Advance the ability to address parents’ past trauma and immediate service needs, and
  • Strengthen child welfare practices and early childhood systems to support the parent-child relationship and optimize the well-being of infants and toddlers in the child welfare system

For more information, view the Infant-Toddler Court Program (PDF - 266 KB).

ECS Resources

Applicant Technical Assistance Webinar Slides for Early Childhood Comprehensive Systems: Health Integration Prenatal-to-Three Program (2021) (PDF - 484 KB)

Early Comprehensive Systems: Health Integration-to-Three Program FAQs

Contact Us

Dina Lieser
Early Childhood Systems Programs Director and Team Lead

Natalie Surfus
ECCS Project Officer

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

Ekaterina Zoubak
ECCS and Rural Health IMPACT Project Officer

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