Early Childhood x Guilford County, NC
Ready for School, Ready for Life (known as Ready Ready) calls itself a backbone organization. But, to deploy another anatomical metaphor, it is also a circulatory system, conveying useful data all around Guilford County, N.C. Ready Ready focuses on the prenatal period through age 3 (expanding to age 5), supporting healthy development and the community resources that make it possible.
Four program partners anchor a partnership called Routes to Ready:
- Community Navigation, a project of the Children's Home Society of North Carolina that provides prenatal and postnatal support for all Guilford County residents. Last year, it fully completed navigation with 1,449 pregnant individuals, or about 25% of the estimated prenatal population in Guilford County.
- Family Connects Guilford,a postpartum and newborn nurse home visiting program at Guilford County Public Health. Guilford County has provided postpartum and newborn nurse home visits for over 20 years and in 2015 adopted the Family Connects International model of postpartum/newborn nurse home visits – launched by Duke University’s Center for Child and Family Policy. Last year, this program served about 2,200 families of the county’s 5,800 families with newborns.
- HealthySteps, ZERO TO THREE’s program that supports early childhood development in pediatric primary care offices and served 17,000 children last year.
- Nurse-Family Partnership, the nationwide program for first-time moms that provides in-home support from a registered nurse through age 2 and served 345 Guilford County families in 2023.
Ready Ready’s Integrated Data System (IDS) connects these partners with each other and with information on nearly 400 community partners housed within its Agency Finder. The system is designed so that every instance of data entry helps to ensure that the next partner along a family’s parenting journey has better insight into past needs and service history. When a family consents to have their information shared in the IDS, Routes to Ready partners can link records to view a set of shared data elements that provide detail on child and caregiver needs and how they have been addressed previously through connections to community services.
Around the country, notes chief impact officer Jacqueline S. McCracken, “Similar organizations are either linking data across partners to improve continuity of service or linking administrative and programmatic data sets for more of an analytic intention. But they aren’t doing both at the same time, and that’s why we're being tapped by other communities. They want to see what we've put in place around tracking our progress and service and how we are using that to improve families’ experiences and outcomes.”
“The Duke Endowment, in partnership with Blue Meridian Partners, is proud to support the creation of this sophisticated data system,” said Meka Sales, director of special initiatives at the Duke Endowment. “Guilford County leaders set a vision over a decade ago to build an integrated data system to serve the goal of improving service delivery for children and families and are doing the work to make this dream a reality. From its inception as a backbone organization, Ready Ready has placed a high value on using data to meaningfully reduce barriers for families, increase connections between providers, and develop insights that can accelerate systems change. Over time, Ready Ready has improved its practices to collect and use data, paving the way for other place-based partnerships across the country.”
Christina Dobson, director of data and performance, says the IDS “breaks down silos between programs and allows for close coordination in serving families in a seamless manner so that families aren't bouncing from one program provider to another, repeating their story anew each time. Our partners can serve families better with higher quality services when they know what has worked or not worked for a family in the past.”
Dobson, who previously worked with the local YWCA and United Way, describes what the experience looks like for Guilford residents, starting during pregnancy: “If you are having a baby in Guilford County, and you and your partner show up for prenatal care, then we have prenatal community navigation, which is connected with 15 of the 17 obstetric sites in Guilford County. At the first prenatal care appointment, typically you would be connected with a prenatal community navigator from Children's Home Society who does a comprehensive assessment of family strengths and needs.”
The navigators, many of whom are multilingual or have personal community connections, engage the family in a guided conversation, identifying needs and referrals and capturing data which may be shared through the IDS. If multiple needs arise during this conversation, navigators will prioritize them because, as Dobson notes, “we understand from the research that you can’t address them all at once. The more referrals you make, the fewer are likely to be secured.”
Ready Ready’s community alignment team helps to ensure that resources and services to meet the needs of families from pregnancy to age 3 are available. “They’re building a robust resource directory that can be used throughout the community,” Dobson says.
Of course, referrals without follow-up are like peanut butter without jelly. “The navigators ask, ‘Hey, what happened with that referral? Did that work out for you?’ Or maybe it didn't, and we need to try something else,” Dobson explains, adding that Ready Ready is scaling up postnatal community navigation for children at ages 1, 2, and 3. With family consent, this information from the prenatal stage flows forward with that family for subsequent interactions with other Routes to Ready partners.
In addition, the IDS drives evaluation, which Dobson boils down to: “How do we know what we're doing here is having the effect that we want it to have?” De-identified data from the IDS are being used by initiative evaluators to complement primary data collection (caregiver surveys) and administrative data sources to provide a picture of what is changing for Guilford County children and families.
Aggregated data from the IDS will also be used to support community-level analytics. McCracken adds that this data can help Ready Ready “understand the landscape of services for children and families in Guilford County and take action to address gaps to understand where services are meeting the needs of families, where it doesn't, and how we can make it better.” The data can help make a case for additional resources or funding as well as restructuring delivery systems to better serve families.
Coastal, a Salesforce implementer, built the IDS for Ready Ready. The collaboration emerged through an advisory council of area partners. “It’s an entirely custom product at this point,” says Dobson, “built with the intention of having a possibility for both expansion to new partners within Guilford County as well as the potential for replication.” Expansion possibilities include layering neighborhood-specific strategies and incorporating voices from the Guilford Parent Leader Network. In response to concerns about data privacy, the organization ensures that families control their own data, allowing them to grant full or limited consent and to revoke consent at any time.
According to Diana Peacock, Coastal’s senior director of the nonprofit practice, IDS constitutes a solid foundation upon which to build new capabilities such as “heat mapping” and other data visualization tools as well as data-sharing agreements with school districts and county government. “Every upgrade makes the IDS more powerful,” says Peacock, “which means better and more actionable connections. Further, thanks to Ready Ready’s vision, the IDS has been designed for scalability, leveraging best-in-class technologies. So the system is built to expand to connect more administrative data sets, partners, and families over time.”
McCracken summarizes: “We are building such a connected system of care. We’re using data to help tell the story of what's happening in our community.”
About the author: Mark Swartz is a regular contributor to Early Learning Nation. The author of the children's books Werner Herzog Eats His Shoe, Lost Flamingo, Magpie Bridge and The Giant of the Flood, as well as a few novels, he lives in Takoma Park, MD, with his wife and two children.