Children's Futures: Improving Health and Development Outcomes for Children in Trenton, N.J.

A comprehensive approach to improving health outcomes for children in Trenton, New Jersey

Dates of Program: August 1998 through December 2013

Children living in poverty have worse health outcomes for infant mortality, developmental delays, asthma, ear infections, obesity, nutrition, and child abuse and neglect. Child poverty also adversely impacts health across the life course and into adulthood.

Description: Children's Futures is a nonprofit organization established in 2001 that fostered public/private collaborations to improve child health and development outcomes for children in Trenton, New Jersey.

Interventions, including home visiting and technical assistance to child-care centers, were designed to increase the percentage of women who receive prenatal care; improve birth outcomes; improve pregnant and parenting women’s access to substance abuse treatment; strengthen effective parenting; improve the quality of child care; and strengthen leadership and agency capacity.

Key Results

During the first five years (2001–2006) of the initiative:

  • Birth outcomes for the babies of participants in the home-visiting program were modestly better than citywide numbers. Home visiting also helped to ensure that pregnant women with medical risks kept their prenatal medical appointments.
  • Child-care centers that received technical assistance improved in all areas of quality care, including hygiene, age-appropriate techniques for play and discipline, increased interaction and communication with children, and improved staff teamwork.
  • Children’s Futures and other organizations advocated that the state health insurance program be extended to cover low-income adults. The law, which passed in mid-2005, allows children to remain eligible for health insurance without reenrolling every six months.

During the second half of the initiative (2008–2013), Children’s Futures lessened its focus on the nurse visiting program in favor of walk-in parent/child centers across Trenton:

  • The initiative’s shift to center-based programming allowed it to reach more parents than in earlier years. In the second five-year phase of the project, some 16,000 participants made 75,000 visits to the centers.
  • Over 90 percent of children participating in the centers were able to enroll in health insurance and have a designated medical home.
  • The home visiting programs supported by Children’s Futures served the perinatal needs of more than 1,000 women.
  • Children’s Futures helped to focus the city’s efforts on prevention. For example, program staff collaborated with partners to: develop an obesity education training module for pediatrics practices; encourage timely immunizations; develop a prenatal, perinatal risk assessment tool; increase parental self-efficacy and the ability to read to their children; and identify children who may have been traumatized by violence.

However, there was no evidence that Children’s Futures’ parenting interventions contributed directly to citywide changes in parenting practices. The effort to design and implement a data system that could be used across the Children’s Futures partner agencies was not successful.

An evaluation team from Public/Private Ventures produced three reports and an article detailing lessons learned for the field in implementing place-based strategies. Among the key lessons:

  • Comprehensive community initiatives require strong and explicit agreement among participating partners about how they will work together, make decisions, communicate, collect data, and evaluate their work.
  • Evidence-based programs are the most likely to be effective, but staff needs intensive training and ongoing feedback to implement them.
  • Launching a successful multi-agency performance management system requires clarity about goals, shared definitions, wise decisions about which data to collect and what technology systems to use, and thoughtful training for staff.
  • Have a strong plan for funding a community initiative over time. If possible, secure matching financial commitments from public agencies before disbursing private foundation funds at the beginning of an initiative.

Citations

Delale-O’Connor L and Walker KE. Rising to the Challenge: The Strategies of Social Service Intermediaries. Philadelphia: Public/Private Ventures, February 2012. Available online.

Walker KE, Arbreton A, Pepper SK, and Farley C. Encouraging Positive Parenting In Early Childhood: Lessons from a Community Change Initiative. Bethesda, MD: Child Trends, May 2013. Available online.

Walker KE, Farley C, and Polin M. Using Data in Multi-Agency Collaborations: Guiding Performance to Ensure Accountability and Improve Programs. Philadelphia: Public/Private Ventures, February 2012. Available online.

Walker KE, Gibbons C, and Navarro M. “Children’s Futures: Lessons from a Second Generation Community Change Initiative.” The Foundation Review, 1(1), 2009. Available online.