Image Credit: Bridgeport Prospers
By Nurture Connection
It really does take a village. That’s a major takeaway from the community-based, multipronged, and almost decade-long approach in Bridgeport, Connecticut, designed to ensure that very young children get the Early Relational Health (ERH) support and services they need to thrive and reach developmental milestones. And efforts are currently underway to replicate this model program in other cities around the state.
Bridgeport is a modest town of 148,654 residents, 84 percent of whom are people of color. The city is home to a significant number of Black residents and immigrants from Jamaica, the Dominican Republic, Mexico, and elsewhere. It is surrounded by wealthy New York City–commuter enclaves. Meanwhile, 52 percent of Bridgeport’s households are cost-burdened, meaning they spend at least 30 percent of their total income on housing, and the average annual income for the city hovers around $50,000. The city’s poverty rate is more than twice that of the state median.
The American Academy of Pediatrics’s Poverty and Child Health in the United States policy statement (released in 2016 and reaffirmed in 2021) brings awareness and understanding of the effects of poverty on children’s physical health, socio-emotional development, and educational achievement. Bridgeport’s journey into centering Early Relational Health for all children and families began in 2016, when early childhood development experts started digging around for data on how young children were faring in the community. They discovered that the only statistics available — which came from Head Start — revealed that a whopping 75 percent of three-year-olds in Bridgeport were behind developmentally, cognitively, socially, and emotionally on entry to Head Start assessment tests.
To understand what was going on in Bridgeport, a group of early childhood professionals and systems leaders convened with community members and set out to do an in-depth landscape analysis of available services and identify resource gaps and barriers to access, according to Allison Logan, an Early Relational Health expert and Nurture Connection Steering Committee member. At the time of this work, Logan was serving as the early childhood project manager for United Way and went on to become the executive director of Bridgeport Prospers, a cradle-to-career, collective-impact program that strives to improve the lives of children, infants, and families in the area.
This was a listening and learning exercise that took over a year via conversations with the community through community baby showers, events, listening sessions, and gathering lived experience data, as well as in-depth conversations with the agencies that provided services to the same community, explains Logan.
That fieldwork included figuring out where Bridgeport residents accessed healthcare, community support, and child-related services. Alongside this work, lived experience data was collected through outreach to individual families via paid community workers (then called community messengers, now known as parent ambassadors) who conducted interviews with community members in places they engaged with, such as churches, bodegas, and community groups. As part of the network to address young childhood developmental gaps in Bridgeport, these community messengers sat at the decision-making table along with early childhood experts and other community stakeholders. Lived experience data showed that there were barriers: Home visits were often associated with the state’s Department of Children and Families, the agency charged to investigate child abuse or neglect and enforce Connecticut’s child protection laws. There were other hurdles, including family stigma around accessing services and challenges navigating the healthcare system.
“Some of the biggest things that came out of the learning were that families felt like the service providers did not represent them, and families had a lack of trust, especially in home visiting and the healthcare system.” says Logan. “There was a stigma that home visiting was for families who were doing something wrong. Families were relaying: ‘Everybody needs support. We all need support.’ So we designed a universal approach system, with the addition of universal supports, alongside more targeted supports for families who needed them.”
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Ultimately, all this legwork led to an initiative launched in 2016 called the Bridgeport Baby Bundle to provide bundled Early Relational Health supports to all city residents with infants, toddlers, and young children. Along the way, the network conducted a slew of activities — including community baby showers, public movie screenings around resilience, and a citywide campaign that encouraged agency and service providers to focus on the first three years of a child’s life through a trauma-informed approach to care. It also held Bridgeport for Babies Day, to highlight the city’s commitment to maternal and infant health and call attention to partner initiatives working toward the same goal. Baby Bundle also incorporated a parental education program as part of the full-court press to address early childhood developmental gaps.
The Bridgeport Baby Bundle framework covers strategies that advance healthy births, responsive services and supports for parents, and on-target development for children through an Early Relational Health lens. A community-wide effort, it includes four universal support “bundles” — education and awareness; a maternity bundle; a hospital bundle; and a pediatric bundle. The Baby Bundle framework focuses on six policy and systems levers for change: universal screening around maternal health and child development; early intervention to support infants and toddlers who have physical or mental health disability, delay, or special needs; universal home visits to support maternal and child health and parental development before and after birth; early childhood education opportunities to enhance children’s cognitive and social development; literacy initiatives to support early learning and brain-building between children and their primary caregivers; and parenting supports, to strengthen parents’ understanding around the science of early childhood development.
The implementation of the Bridgeport Baby Bundle incorporated a multiyear, multipronged Bridgeport Basics campaign to promote healthy brain development of children by encouraging nurturing, responsive, brain-building interactions between parents and kids from birth to three years. It also included supporting the adoption of the Sparkler mobile app, which helps parents to check in on how their child is doing against key milestones — and provides activities to spark their early learning. Expanded local doula services to federally qualified health centers and the expansion of the national Reach Out and Read program have also been part of building a holistic system of care for Bridgeport families.
The Baby Bundle framework, which took about six years to build and implement, realized early on that to develop and customize this kind of collective impact effort required a resource and time commitment of three to five years. A five-year timeline for the Bundle framework also provided the opportunity to focus simultaneously on building community support and service provisions while shifting to a sustainable financing model. In 2020, the Bridgeport Baby Bundle received national attention and was funded for a three-year Community Innovation Grant from the Pritzker Children’s Initiative.
Since then, the program has been credited with improving the health and well-being of Bridgeport’s infants and toddlers in a variety of ways. In the three years prior to the program launch, roughly 25 percent of three-year-olds entering Head Start were assessed as meeting expected developmental milestones. In the two years following the program launch, that number increased to 35 percent, with more positive signs on the horizon. Additional family data gathered at Bridgeport’s two birthing hospitals has shown that more families are participating in critical social services offerings. Universal Home Visiting was initiated and has seen significant uptake as part of the Baby Bundle implementation, with a 72 percent completion rate. Similarly, pediatric literacy programs such as Read to Grow and Reach Out and Read have also been able to grow their footprints and touch more families, as a result of being affiliated with the Baby Bundle program, with 95 percent of pediatric primary care offices now hosting Reach Out and Read.
Logan and a group of early childhood leaders are now building upon the success of the Baby Bundle framework with a statewide systems change initiative called the CT 359 Network. The network is a diverse group of individuals and organizations who all wish to contribute to the outcome that all of Connecticut’s children are “on target and thriving” at the ages of three, five, and nine.
“This is the ultimate legacy and success of the Baby Bundle initiative,” says Logan. “Moving the early childhood field from thinking about individual programs and services to building a holistic system of care for families of young children in Bridgeport and across the entire state of Connecticut.”
This blog post is part of Nurture Connection’s “ERH in Action” series of listening and learning sessions. Our network is full of meaningful examples of people and organizations promoting ERH in their daily lives and work. Our “ERH in Action” series highlights and uplifts stories from various fields to share learnings, challenges, and bright spots in the movement.
You can read more about the CT 359 Network in part two of our ERH in Action series looking at practice transformation in the early childhood field in Connecticut.