The Early Childhood Innovation Network—Shifting the paradigm of health for young children

What if every child—especially facing adversity—were surrounded by adults with the best strategies to help them become thriving adults?

Photo of Lee Beers
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Founding Story: Share a story about a key experience or spark that helps the network understand why this project got started or a story about how you became inspired about the potential for this project to succeed.

I am the pediatrician for two young children who witnessed their parents murdered in front of them. Despite this horrific early trauma, they are both thriving in the care of a loving relative and with the support of a trauma-informed interdisciplinary team. Experiences like this inspired me, along with the initiative's co-director, to create this Network that will build a strong foundation across all realms of young children's lives and remove barriers so they can reach their fullest potential.

Which categories describe you? (the answer will not be public)

  • White (for example: German, Irish, English, Italian, Polish, French, Caucasian)

Location: Where is your organization headquartered? [State]

  • District of Columbia

Location: Where is your organization headquartered? [City]

District of Columbia

Location: Where is your project primarily creating impact? [State]

  • District of Columbia

Location: Where is your project primarily creating impact? [City]

District of Columbia

Problem: What problem is this project trying to address?

Nearly 1 in 3 children in Washington, DC is born into poverty and 1 in 2 has at least one adverse childhood experience (ACE). ACEs during the first 5 years can have an especially devastating effect on biopsychosocial development and the damage may persist across the lifespan. Yet, our community lacks the capacity for swift, coordinated, and effective responses to help families buffer harmful stress and avoid tragic, costly life trajectories.

There are two distinct ways of defining 'solution' with this project. The first type of solution is the Early Childhood Innovation Network (ECIN), a city-wide initiative which provides the overarching infrastructure for identifying and deploying groundbreaking early childhood interventions—these comprise the second type of solution.

The Early Childhood Innovation Network (ECIN) is based in a transformative partnership between Children's National Health System and MedStar Georgetown University Hospital and was officially launched in late 2015. We know that artificial silos persist despite glaring evidence from the scientific literature that child development observes no such separation: children living in highly stressed environments struggle in ways that simultaneously impact learning, social relations, physical health, and emotional stability; therefore, the ECIN founders are highly inclusive with their approach. The ECIN's initial 5-year implementation plan is phased in order to manage this complex growth and ensure success.

It is vital to underscore that while primary care and early childhood education providers are important contributors to a child’s health and development, the family is the first and most consistent influence. Models or interventions that do not engage and support the family in the settings where they live, work, and play are destined to be less effective and often fail. Environmental, neighborhood, and family influences can impact a child’s chances for success even before they are conceived. Effective interventions can change the fabric of a family and community, and have an impact for generations to come. Unfortunately, though many programs are available in the community to support families, they are often under-resourced, short-lived, ill-coordinated with other efforts, and offer interventions not based in sound evidence. To truly improve child and family outcomes, it is important to raise the level of the services available to families and support community-based agencies in their dedicated and earnest efforts to improve the lives of children in their neighborhoods.

Thus, the unique power of the ECIN derives from a diverse city-wide community of stakeholders and advocates who are committed to creating lasting systemic change for the wellbeing of the District's children. The ECIN is designed as a comprehensive cross-sector platform that integrates innovation, education, research, and advocacy. In addition to Children's National Health System and MedStar Georgetown University Hospital, the Children’s Law Center, the DC Chapter of the American Academy of Pediatrics, and the Johns Hopkins Bloomberg School of Public Health have key roles in leading and shaping the ECIN. A host of pediatric healthcare providers, government public health officials, educators, community health organizations, and insurers are participating in the ECIN's first phase of efforts to improve how the District approaches pediatric mental health. We also see that many Ashoka members align closely with the ECIN and we welcome the opportunity to build alliances with them moving forward.

The ECIN Vision:

  • Children in our city will receive the best possible start in life, setting the stage for long-term health and success
  • Providers, such as pediatricians, early childhood educators, and social support workers who interact with young children will work collaboratively, synergistically, and with a minimum of duplication towards the common goal of strengthening families
  • Systemic policies and procedures will ensure children, families, and providers are able to access the high-quality interventions and timely supports they need
  • Evidence and research will rigorously inform program development and guide expansion and replication, serving as a best practice model for the nation.


The ECIN’s lean core team serves as the hub of the Network and engages in high levels of communication with the Network partners in order to support their involvement. The team also builds the mechanisms needed for true collaboration. Members work closely with public, private, and philanthropic partners in the metropolitan Washington, DC region to find, test, adapt, and spread new and better solutions to early childhood challenges that truly work. They look specifically for previously proven, cost-conscious interventions in the early childhood space. These relevant solutions tend to increase individuals’ capacities to learn, work, and earn; lower crime rates; save spending on special education and social safety nets; and reduce the healthcare costs of common and expensive chronic health conditions. The initiative utilizes rapid-cycle quality improvement techniques and scientific measures, incorporating early findings and frequent feedback to maximize the interventions’ value to children and families—we call this process 'microtrials'.

Once an intervention proves effective for our community, it becomes independently and sustainably embedded in our pilot partner's setting and also disseminated more broadly with the aim of establishing it as a common best practice. We then move on to assessing and integrating other promising interventions. The core elements of our theory of change are to promote strong and responsive family and caregiving environments; to cultivate resilience early in life; and to advance a national model informed by the latest knowledge for a thriving and sustainable society.

Due to its nimble design, the ECIN has eyes and ears on the ground, learning about barriers across the District that stand between effective interventions and the children and families who need them most. Often, providers identify problems but lack the city-wide data to back up their concerns. The ECIN will use its infrastructure to collect and aggregate this information. By applying lessons learned and the most compelling findings that demonstrate problems, community need, and strategic solutions, the ECIN will drive lasting improvements at many levels—institutional policy, local regulation, and legislative action. Our collaborations with the Children’s Law Center, Children’s National’s Child Health Advocacy Institute, and the Georgetown Center for Child and Human Development have been extremely powerful in the past; and we look forward to further leveraging them to impact even more substantive and enduring change. Most importantly, our team and collaborators’ reputations as being mission-driven, action-oriented professionals give us great influence and the ability to make compelling, comprehensive recommendations.

In addition to the thousands of lives the ECIN will directly enhance, ultimately it is intended to bring about a culture shift across domains—most notably home, health care and education. These policy targets have local focus and national significance, with the potential to advance systems’ capacities to prioritize policies that improve childhood outcomes.

Is your model focused on any of the following traditionally underserved communities?

  • Communities of color
  • Children who are differently abled
  • Low-income communities

Does your model work within any of the following sectors?

  • Childcare
  • Child and Family Services
  • Community Development and Empowerment
  • Education
  • Mental Health
  • Other

If you chose "other," please share the sector you work within here:

Health care

Year Founded

2015

Project Stage

  • Start-Up (a pilot that has just started operating)

Example: Walk the network through a specific example of what happens when a person or group engages with your solution.

The following sample ECIN pilot will be implemented at a community-based medical home clinic in DC's most under-resourced neighborhood beginning in the fall of 2016. This primary care project will incorporate an early childhood mental health specialist and a family support worker to engage with a family every time they come for a child's well visit from birth on. The care team will be trained to recognize toxic stress and deploy effective interventions to reduce its effects. Mental health screening will be integrated as an essential component of routine care, thereby normalizing any signs of concern. The family will be provided with support and education, guidance to promote attachment, and connections to specialized community resources.

Impact: What was the impact of your work last year? Please also describe the projected future impact for the coming years.

The ECIN evolved from a collaborative that began in 2012 to integrate mental health and primary care services for the District's children. One early outcome was a 353% increase between 2013 and 2015 in developmental/behavioral health screenings (ages 0-20) that were billed to Medicaid. This dramatic shift was largely due to a Learning Collaborative established to help pediatric practices integrate such screenings into well visits. Since 70% of DC's children on Medicaid are seen by these practices, we achieved deep reach into high-risk families. We also advocated for new Medicaid policy allowing for reimbursement for mental health screens. This model of interdisciplinary upstream solutions serves as the cornerstone for the ECIN's full launch early this year. We anticipate exponential impact, with special emphasis on early childhood.

Organization Type

  • nonprofit/NGO/citizen sector

Annual Budget

  • over $5mil

Financial Sustainability Plan: What is your solution’s plan to ensure financial sustainability?

Financial sustainability is integrated into the ECIN business model. A groundswell of interest by the local philanthropic community points to significant potential from private channels. Early ECIN success built confidence and set the stage for diverse financial investments. We are planning to explore other strategies as well: 'pay for success' bonds, reimbursement, government grants or contracts, dedicated research funding, and in-kind support.

Unique Value Proposition: How else is this problem being addressed? Are there other organizations working in the same field, and how does your project differ from these other approaches?

The ECIN engages key partners, experts, policymakers, and community stakeholders through a collective impact approach to identifying, addressing, preventing, and reversing the harmful effects associated with toxic stress in early childhood. Collective impact initiatives mobilize and facilitate strategic partnerships between organizations with shared intention and utilize a structured process, centralized infrastructure, and dedicated staff to advance a shared agenda with actionable, measurable outcomes. The employment of rapid evaluation through microtrials further distinguishes our approach.

Reflect on the Field and its Future: Stepping outside of your project, what do you see as the most important or promising shifts that can advance children’s wellbeing?

A major important step forward is the collective admission that our current systems of care are woefully inadequate, fragmented, and failing our children and families in distress. There is also increasing public policy and scientific consensus about the critical impact of early childhood development on long-term health and educational outcomes. There is a clear need to create a wholly integrated, evidence-based but locally grounded response in the nation’s capital, where effective interventions for vulnerable families may have particular potential to emerge as a national model.

Source: How did you hear about the Children’s Wellbeing Challenge? (the answer will not be public)

  • Email

Referral: If you discovered the Challenge thanks to an organization or person other than Ashoka, who was it? (the answer will not be public)

The Robert Wood Johnson Foundation via email

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Team

Lee, I am excited to read about this great program. I am a pediatrician in Louisville, KY working to start the Smoketown Family Wellness Center. While much smaller scale than your work, there are many shared concepts: integration of mental health as a vital part of overall health, the importance of evaluating for ACEs, the importance of breaking through silos to work together to support children. Please review our proposal. I would love to talk with you about your work!

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