Vertical and Horizontal Continuity of Care for Children

This chapter considers the implications of the science described in Part II for why it is important to create greater continuity in the systems in which the professionals who are the focus of this report work, in turn creating greater continuity in positive, high-quality experiences and environments for young children over time. The concept of "continuity" has two facets when it comes to children from birth through age 8. First, it denotes the consistency of children's experience across diverse care and education settings as they grow up. Viewed in this way, the vertical continuity of high-quality learning experiences for children over time includes the alignment of learning expectations; curricula; and other instructional strategies, assessments, and learning environments to ensure that they are coherent with each other and grounded in the science of child development and of best practices in instruction and other professional responsibilities. With this continuity, early achievements prepare for and are built upon by later ones. Second, continuity refers to the coordination of services and agencies affecting children at any given point in time. This horizontal continuity includes policies and systems for consultations, referrals, and follow-up. It encompasses the need for communication and collaboration among care providers; early educators; health care providers; community support agencies; and, when the need arises, social services and mental health professionals. It also extends to communication and collaboration with families concerning the needs of the child and the services that are provided so that there is alignment in understanding the child's needs, and the practices of professionals and families are complementary. Shared knowledge among these service sectors and between providers and families enables coordination.

Why is continuity of high-quality experiences so important to supporting children's development? As noted throughout Part II, children's growth across all domains is rapid and cumulative. Development and early learning provide a foundation on which later learning is constructed. Continuity is necessary to ensure that children's experiences in care and education settings contribute consistently to these developmental achievements and that early problems are quickly identified and addressed. When vertical continuity over time results in consistent high-quality learning experiences, it helps ensure that early learning achievements prepare children for later achievements such that children's early competencies build on each other over time instead of stagnating or slipping backward. For example, gains made as an infant and toddler need to be built upon in preschool programs, and additional gains made in preschool need to be built upon and extended when children progress to kindergarten and early elementary classrooms.

This vertical continuity requires communication, planning, and coordination among care and education practitioners across the diverse settings that influence children from birth through age 8, including home visitation, early care and education, preschool programs, and elementary schools. When successful, this continuity means that practitioners working with children of any age are aware of the learning experiences that have preceded and those that will follow. This continuity also requires special attention, including communication with families, to young children's transitions between programs, when changing personnel, expectations, and settings can be disruptive.

Horizontal continuity at each developmental stage helps ensure that the diverse programs and agencies affecting children provide coordinated services. This continuity requires coordination and communication among practitioners in different fields and systems. The need for this can arise among diverse types of practitioners and programs within the care and education sector, for example, if a toddler is enrolled in an early education center and also is receiving early intervention services at home. Young children often are enrolled in multiple programs, which need to be aligned in their expectations of high quality for children's experiences, their learning environments, and the practitioners who work with them. The need for horizontal continuity also arises between care and education and other sectors, most often health care, mental health, and social services. The purpose is not only to coordinate services for individual children and their families, but also to create shared understanding of the interconnected quality of developmental processes that each practitioner may see only in part. One result of such continuity is greater opportunities for successful and effective consultation and referrals across professional sectors.

As discussed in Chapter 2, however, the landscape of systems and settings for young children and their families—from both a horizontal and vertical perspective—is complex, and unfortunately it typically is uncoordinated and segmented and too often fails to deliver consistent high-quality experiences for children.

CREATING A CARE AND EDUCATION CONTINUUM

The ultimate goal of a stronger, more seamless care and education continuum is to initiate and sustain a strong foundation for future success by providing effective learning opportunities across the infant-toddler years, preschool ages, and early grades in all settings, including the home, family childcare homes, childcare centers, preschools, and elementary schools. Bringing multiple systems together to make the high quality of early learning opportunities and supports more coherent and consistent as children grow requires coordination and alignment across the many interconnected components of the care and education of children from birth through age 8 described in Chapter 2: public school and other elementary education systems; center-based or school-based programs and services for children younger than kindergarten age; other non-center-based settings for care and education, such as family childcare providers; and consultative or supportive services for young children administered by different agencies and occurring in various settings, such as home visiting and early intervention services.

Creating a stronger continuum and bridging the gaps among different systems and settings entails significant conceptual and logistical challenges for the stakeholders involved: care and education practitioners; leaders, administrators, and supervisors; those who provide professional learning for the care and education workforce; policy makers; health, mental health, and social services providers; and parents and other adults who spend time with children. These different settings and the different professionals who work within them are characterized by differences in terminology, expectations, approaches to teaching and learning, and relationships with families and the community. This fragmentation is due in part to the disparate histories of these professional roles and in part to differences in accountability policies, funding streams, governance, and system priorities and pressures.

The extent to which individual care and education professionals in these settings can foster greater consistency and continuity for children and families throughout the birth through age 8 continuum depends partly on their knowledge and competencies and how they put these into practice in the settings where they work. However, it also depends largely on whether policies and systems at the local, state, and national levels encourage, require, facilitate, or impede continuity and alignment. Several recent analyses have identified ways of overcoming the conceptual and logistical challenges to greater alignment (see, for example, Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Kauerz and Coffman, 2013; Tout et al., 2013). Across these analyses, the goals of alignment efforts are to develop

a shared vision of developmentally based, high-quality learning in early learning and elementary school settings;
a common foundation of knowledge, competencies, norms, and processes for high-quality professional practice and professional collaboration and communication within and across professional roles, settings, and ages from birth through early elementary school;
a mutual understanding of policies, circumstances, and attributes across settings, systems, and professional roles; and
implementation plans within and across settings that build on a shared vision, a common foundation, and mutual understanding in learning environments, leadership, policies, and accountability systems.

The efforts needed to achieve these goals have been articulated in slightly different ways, but many common elements emerge, discussed here in the following categories: professional learning and workforce development; early learning standards; instructional strategies; learning environments; child assessments; accountability systems and data-driven improvement; family engagement; pathways for vertical continuity for children; and coordination and communication across professional roles, settings, and policies. This committee was charged with focusing on one of those categories—professional learning and the development of the workforce—but describing this broader range of elements provides context for how the workforce fits into larger efforts to strengthen the care and education continuum. Doing so is important because the different elements overlap and are interconnected, and are best considered together rather than in isolation. Evidence indicates that the more of these elements are implemented well, the more likely it is that efforts will yield the desired outcomes for children (Kauerz and Coffman, 2013).

Professional Learning and Workforce Development: Effective Educators and Leaders

Educators and leaders across the care and education continuum for children from birth through age 8 must possess the knowledge and competencies required to promote learning and development for all children and to address challenges faced by children and families in vulnerable situations (Sadowski, 2006). Opportunities for professional learning vary widely depending on the settings and sectors in which professionals work, and it is particularly challenging to provide effective professional learning in an integrated way for educators working with children from birth through age 8 (Tout et al., 2013). Doing so will require revisiting core competencies, practice standards, and polices as needed and reenvisioning professional learning for practitioners and leaders, certification systems, and systems for evaluation and accountability, among other steps. For a detailed discussion of professional learning and workforce development, see Part IV.

Early Learning Standards

Alignment of learning standards across the birth through age 8 continuum is critical for providing continuity in learning and program quality and supporting children as they transition between settings and learning environments. Developmentally appropriate standards set expectations for what young children should learn and the concepts they should understand. These early learning standards, also often referred to as early learning guidelines, typically reflect expectations within domains of development and learning, such as socioemotional competence, cognitive development, general learning competencies, and specific content areas, including literacy, mathematics, science, social studies, and arts. These standards provide teachers with guidance for developing activities and lessons that reinforce these expectations. Early learning standards also have other implications for educators and for instructional practice as they can shape expectations for educator competencies and quality standards for programs, services, and schools, as well as the policies needed to support those standards and expectations. Thus, early learning standards are one way to improve multiple dimensions of practices, systems, and policies, and they can be an important lever for supporting quality and building continuity among and within systems—provided that they reinforce a shared vision, are built on a shared foundation, and are aligned for all ages, including K-3 academic standards (Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Kauerz and Coffman, 2013; Tout et al., 2013) (see Figure 5-1).

FIGURE 5-1

A theory of change for the role of learning standards. NOTE: ECE = early childhood education; DLL = dual language learner; KEA = kindergarten entry assessment; Prep, PD & Eval = preparation, professional development, and evaluation; QRIS = Quality (more...)

Early learning guidelines developed by states describe what children should know and be able to do during specified age ranges—sometimes birth through age 3, sometimes preschool, sometimes birth to age 5 (Scott-Little et al., 2010). The National Education Goals Panel (NEGP) identified five dimensions of learning and development of young children: "(1) children's physical well-being and motor development; (2) social and emotional development; (3) approaches to learning; (4) language development; and (5) cognition and general knowledge" (NEGP, 1995, p. 3). These domains, for the most part, provide the framework for the states' early learning guidelines (Barnett et al., 2012; Kagan et al., 1995; Scott-Little et al., 2008). The development of early learning guidelines resulted in part from the federal 2002 Good Start, Grow Smart early childhood initiative, which encouraged states to create voluntary early learning guidelines on language and early literacy skills for children aged 3-5. These guidelines were to be aligned with state public school standards and adaptable to various childcare settings (U.S. White House, 2002). Early learning guidelines for infants and toddlers are more recent.

Early learning guidelines for preschool-age children have been developed for all 56 states and territories, and almost all have early learning guidelines for infants and toddlers. Sixteen states have combined guidelines for children from birth to age 5. The majority of states have either aligned or are in the process of aligning their guidelines across age groups and with the Common Core State Standards for early grades (Barnett et al., 2012; National Center on Child Care Quality Improvement, 2014).

Early learning guidelines articulate age-related benchmarks for development in early childhood so that professionals will use appropriate educational instruction and practices that support child development. They also may serve as a tool for educating parents and the public about child development and learning. Further, policy makers can reference early learning guidelines to support high-quality programs and, by linking the guidelines to elementary expectations, contribute to continuity in children's education (Gebhard, 2010; NAEYC-NAECS/SDE, 2002; Scott-Little et al., 2007, 2008).

When early learning standards were first being developed, some early childhood advocates worried that they carried risks, and experts have stressed safeguards for their appropriate use. One concern was that the standards might not represent the diversity of development and learning in the early years and might wrongly result in labeling a child as an early educational failure, potentially denying the child access to other educational opportunities. Similarly, programs might be unfairly criticized based on children's performance. In addition, there was concern that curricula and instructional practices might be driven by standards that might not be comprehensive and that the goal of ensuring that children in the aggregate would meet the standards might be met at the expense of supporting children's individual learning and growth according to their progress along developmental trajectories (Kagan and Scott-Little, 2004; NAEYC-NAECS/SDE, 2002).

In a joint position statement, the National Association for the Education of Young Children (NAEYC) and the National Association of Early Childhood Specialists in State Departments of Education (NAECS/SDE) (2002) hold that early learning standards can contribute to a comprehensive, high-quality system of services for young children provided they

emphasize significant, developmentally appropriate content and outcomes;
are developed and reviewed through informed, inclusive processes;
use implementation and assessment strategies that are ethical and appropriate for young children; and
are accompanied by strong supports for early childhood programs, professionals, and families (NAEYC-NAECS/SDE, 2002).

Instructional Strategies

Coherent instructional strategies provide children with a consistent, connected series of learning experiences. Such coherence is based on research that guides standards, goals, and pedagogical strategies. Specific learning goals and activities for each age should be connected along a developmental progression (or learning trajectory) to ensure that they are developmentally appropriate, meaning that they are "challenging but attainable for most children of a given age range, flexible enough to respond to inevitable individual variation, and, most important, consistent with children's ways of thinking and learning" (Clements, 2002; Clements et al., 2004). (Learning trajectories are discussed in greater detail in Chapters 4 and 6.) Dual language learners and children with disabilities should be supported through the use of appropriate educational models tailored to these populations, for which specific strategies have been developed (Bornfreund et al., 2014; Tout et al., 2013).

Educators promote coherence through a deep understanding of the content to be taught, knowledge of children's thinking and learning of that content that encompasses development across ages, and expertise in how instructional tasks and strategies promote this learning, complemented by a thorough understanding of each individual child's progress. When there is consistency from one learning environment to the next and communication and collaboration among educators, children are able to establish connections between lessons, between ideas and processes within a topic, between topics, and between learning from one year to the next.

A comprehensive set of standards for instructional strategies can assist program directors and educators in developing well-rounded curricula that are intentional, relevant, balanced, and clearly sequenced. Such standards also can help provide continuity in learning experiences across settings from birth through third grade (Bornfreund et al., 2014). State standards should specify that curricula

be research based,
support foundational competencies for children,
guide both the content and process of teaching, and
be reviewed periodically and refined or replaced as needed (Kauerz and Coffman, 2013).

Instructional strategies are discussed further in Chapter 6.

Learning Environments

Evidence indicates that children benefit when learning environments meet well-defined measures of high-quality care and education (Annie E. Casey Foundation, 2013; Tout et al., 2013). The physical environment and socioemotional climate that contribute to favorable outcomes for children encompass learning environments that are sensitive to all cultures in the community; promote positive relationships for children and adults; and are structured and supplied with resources to support a breadth of developmental levels, abilities, and interests. Adequate and safe indoor and outdoor spaces, as well as dedicated areas for adults to collaborate in planning and decision-making processes, are necessary to support active learning and instruction. Care and education professionals need to create organized environments that support learning and the socioemotional development of children. The availability and use of a variety of resources that encourage different sensory experiences and explorations and subject-matter content (e.g., books, manipulatives, technology) are important to children's learning (Kauerz and Coffman, 2013), as are environments that are easy for young children to navigate autonomously to pursue interests.

Care and education professionals need to create environments that are sensitive to the diversity of cultures and languages that children bring to the classroom and to the importance of educating all children about the diversity they will encounter in the world. Such environments include materials that reflect this diversity, including images and toys that depict people from different countries, of different skin colors, in varying family configurations, of different ages, and of different abilities.

The number of hours spent in early education programs also can influence a child's learning and development. Research has found that children attending full-day preschool and kindergarten programs have better academic outcomes than those attending half-day programs (Tout et al., 2013). It has been suggested that children should attend prekindergarten and kindergarten for the same number of hours per day as first grade (Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Tout et al., 2013). However, for early learning settings for young children there also is growing evidence that the number of hours associated with full-day attendance can be psychologically and biologically stressful for some young children, especially when starting to attend childcare settings early in life, which may contribute to socioemotional and other developmental difficulties (Dmitrieva et al., 2007; Sajaniemi et al., 2011; Watamura et al., 2003).

Child Assessments

Assessment is used to measure children's developmental progress. Assessments also are used to guide intervention and instruction and evaluate the performance and effectiveness of programs and services (Kauerz and Coffman, 2013; NRC, 2008). A comprehensive system includes diagnostic, formative, and summative assessments. Assessments that are developmentally, culturally, and linguistically appropriate provide accurate data that can inform the instructional paths or interventions needed to support a child. Assessments should be designed for a specific purpose and be aligned across all levels, from early learning programs through preschool to K-3 (Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Kauerz and Coffman, 2013; Tout et al., 2013).

Screening is another form of assessment for eliciting important information about whether a child is progressing as expected. Screening can indicate whether further diagnostic assessments are needed and which intervention services may be warranted. Follow-up action typically requires coordination among families, early educators, and medical or early intervention specialists (Tout et al., 2013).

If data collected through child assessments are to lead to beneficial change, professionals must be trained not only in how to administer them but also in how to interpret their results and apply that information in altering instructional practices and learning environments (Kauerz and Coffman, 2013; Tout et al., 2013). Data collection, interpretation, and sharing in ongoing practice also need to be supported through structured and facilitated means to ensure the quality of data analysis, interpretation, and use. Leaders in educational settings and systems, as well as oversight policies, must support the time and structures needed if assessment data are to fulfill their potential to inform day-to-day instructional practices, professional learning, and organizational planning. In many settings, a shift may be required to decrease the volume of data collection and reorient from a focus on reporting and compliance to emphasize time, support, and resources for data analysis, interpretation, and use (Lesaux et al., 2014).

Child assessments are discussed further in Chapter 6.

Accountability Systems and Data-Driven Improvement

A National Research Council (2008) report on early childhood assessment cautions that it is inappropriate to use data from child assessments independently. Rather, it is important to

measure children's progress rather than end-of-year status,
collect data on direct indicators of program quality,
collect data on the risk status of families and children,
collect data on program resources (e.g., funding, administrative support, professional development), and
have a clear plan for program improvement (Tout et al., 2013; Zaslow and Halle, 2009).

Accountability systems utilizing various data sources can be used to improve instructional practices, the provision of services, schools and early care and education programs, professional development, and Quality Rating and Improvement Systems (QRISs), as well as to inform the efficient allocation of monetary resources (Kauerz and Coffman, 2013; Tout et al., 2013). These systems for accountability can help measure progress toward identified goals with defined benchmarks and outcomes (Tout et al., 2013).

Developing longitudinal data systems that are linked among early childhood providers and programs, K-12 schools, and state agencies and that can be disaggregated by age, gender, race/ethnicity, and socioeconomic status, among other factors, can inform strategies for improving program quality and child outcomes. Appropriate assessment methodologies specific to the individual, program, or system being assessed need to be identified and linked. As with individual child-based assessments, valid data collection that can effect beneficial change requires that administrators, care and education professionals, and families receive instruction on the data collection methodology and interpretation of the data (Kauerz and Coffman, 2013; Tout et al., 2013). The need for responsible data use and interpretation means not only that practitioners must be taught how to interpret results and apply that information to make changes, but also that data sharing be conducted through structured and facilitated means to ensure the quality of the data analysis, interpretation, and use. Data gathered from these systems must be used responsibly to inform instructional practices as well as policy and strategic decisions that will ultimately lead to improved child outcomes (Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Kauerz and Coffman, 2013; Tout et al., 2013).

Family Engagement

Family engagement focuses on building strong relationships between families and staff along the continuum of care and education settings and community programs (Tout et al., 2013). Educators and administrators need to establish a two-way dialogue with families so as to share responsibilities, data, and decision making in support of children's development and learning (Kauerz and Coffman, 2013; Tout et al., 2013). Parents and families have the strongest influence on the growth and development of their children, and the aim of family engagement is to bring staff and families together around the common cause of supporting children's development and learning. Families have valuable knowledge to share with the people helping to care for and educate their children, from the characteristics of a particular child to more general cultural funds of knowledge. Educators and administrators benefit from taking an approach of respectful inquiry when it comes to understanding families' cultural beliefs and practices around, for example, such issues as eating and sleeping, attachment and separation, and the role of play in learning. It is also important to support parents and families in their understanding of child development in order to engage them in their children's education. Care and education professionals also can promote responsive and culturally appropriate parenting, as well as respect for and understanding of the home language and culture, and encourage or facilitate formal and informal support networks. Moreover, supports can be provided at the policy level; many policies can affect various aspects of life for parents and families, including economic stability, education, and health (Tout et al., 2013).

Federal and state government programs such as home visiting, nutrition assistance, childcare assistance, and abuse and neglect prevention provide such support. Parent education programs offer parents knowledge of what to do to encourage their children's success. Policies also can affect the economic stability of families. For example, encouraging successful employment of the adults in a family through education and training programs promotes economic stability for the family. Other important strategies are designed to enable parents to take advantage of such programs by making navigation of systems more manageable—for example, aligning eligibility requirements, streamlining benefits, or offering different modes of applying for services (Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Tout et al., 2013).

Family engagement is discussed further in Chapter 6.

Pathways for Vertical Continuity for Children

From birth through age 8, children undergo a tremendous developmental period, including physical, cognitive, and socioemotional development (see Chapter 4). During this period, a continuous pathway of high-quality, evidence-based care and education for all children and integrated support are associated with later academic and social success.

The transition to a new setting (for example, when a child is moving from home to a center, from family childcare to a preschool, or from a preschool to an elementary school) can be a major adjustment for young children—a challenge compounded by disconnects or misalignment among systems. For example, the learning environments children encounter in childcare settings can be very different from those in kindergarten classrooms. Transitions within settings also can be challenging for children as they move from year to year in childcare settings and grade to grade in elementary schools (Tout et al., 2013).

Making explicit connections between learning environments can help ease the adjustment for young children and reduce adverse consequences that may result from stresses encountered in transitioning. Bridging activities designed to ease transitions can support and sustain the growth of children's competencies across developmental domains (Bornfreund et al., 2014; Tout et al., 2013). Bridging activities employed within settings or classrooms include having mixed-age classrooms or having an educator move with a group of students for multiple years—for example, to teach the same class of children from ages 3 to 5 or from kindergarten through second grade before starting again with a new class. The success of these approaches will depend on the availability of educators employing a high quality of professional practice, to avoid a cumulative negative effect of children experiencing consecutive years of a low-quality learning environment rather than the desired continuity of a high-quality learning environment. Across settings, bridging activities might include developing partnerships within a community among early care providers, community-based organizations, preschools and elementary schools. Expanding access to high-quality learning programs, including preschool for all low-income children and after-school or extended learning opportunities, is necessary for this approach to be viable. Parental involvement in planning for transitions also has been shown to be instrumental in children's success (Annie E. Casey Foundation, 2013; Bornfreund et al., 2014; Kauerz and Coffman, 2013; Tout et al., 2013). Policies and practices such as standardized forms and processes across settings and age/grade levels and aligned standards, curricula, teaching practices, and assessments can facilitate transitions as well (Annie E. Casey Foundation, 2013; Kauerz and Coffman, 2013). Additional bridging activities and supports are needed for children who are receiving supplemental support services—for example, children receiving early intervention services at home who are transitioning to special education services in a center or school.

Continuity at Kindergarten Entry

Kindergarten entry in particular is a point of discontinuity for young children that has received increasing attention in recent years. For some children, this is a first transition from the home environment to a care and education setting. Even for children in care and education settings prior to kindergarten, the experience in family childcare settings, center-based childcare, and preschools, and even prekindergarten programs in schools, can be very different from the environment of kindergarten, which is typically in an elementary school embedded in a K-12 system. Similarly, the practice environment and professional learning background is typically very different for educators and leaders in settings before kindergarten and those in elementary schools.

The concept of "readiness" to start school has been recognized as encompassing a variety of components. At the level of an individual child's developmental progress, it includes not only cognitive development, language development, and early knowledge in subject areas but also socioemotional development, physical development and health, and growth in learning competencies. It encompasses a child's ability to undertake the learning of specific content (e.g., vocabulary, conceptual skills, progress on early learning trajectories for core content areas such as literacy and math), as well as a child's physical, emotional, social, and behavioral preparedness to engage in the kindergarten and early elementary learning environment.

However, "readiness" is not just a construct at the level of the individual child. Families and communities also are important in the transition to the kindergarten setting, as is the "readiness" of elementary schools to receive the children they serve (Kagan et al., 1995; Shepard et al., 1998). Thus, "readiness" means as well that professionals and the systems in which they work are equipped to facilitate smooth transitions between home and school, as well as to establish continuity between early care and education settings and elementary schools. According to Pianta and colleagues (1999), transition practices of "ready" schools include (1) developing connections with families and preschools, (2) establishing connections even before the first day of kindergarten, and (3) utilizing proactive strategies such as home visiting to make personal connections with children and families.

Through a review of research on the transition to kindergarten, Tout and colleagues (2013) identified promising strategies schools can use to offer support to children. These include forming partnerships among children, parents, and teachers; ensuring that parents understand their role in their child's education; and encouraging professional learning for educators. Research shows that establishing connections between developmental contexts during critical transitions can help ease the stressfulness of these transitions and support and sustain the acquisition of new skills and abilities. For example, Schulting and colleagues (2005) followed a cohort of children across their kindergarten year to examine how child outcomes are affected by school-based transition policies and practices. Their findings indicate a significant association between transition practices and positive academic outcomes at the end of the school year. This effect was strongest for children of low and middle socioeconomic status and was attributed in part to a positive correlation between the transition practices and parent-initiated involvement during the school year. In addition to family engagement in children's learning experiences, family and community involvement entails supporting high-quality comprehensive services to support families, which are critical in particular for fostering at-risk children's overall development and school success (Daily et al., 2010).

Alignment of early learning standards with K-12 curriculum standards, as well as standards across systems for programs and professional practice standards, is necessary to create continuity across the systems through which children transition (Daily et al., 2010). Further, aligning formative assessments across early childhood and early elementary years can ensure that educators are prepared to support children's continuing development consistently during transition periods (Graves, 2006; Tout et al., 2013). If the alignment and use of such assessments are to be effective, precautions and systems must be in place to define the purpose of the assessments clearly, to train care and education professionals in their use, and to provide tools that facilitate appropriate interpretation and use of the results (Daily et al., 2010).

Several states and localities are institutionalizing this process by adopting kindergarten entry assessment systems. Under the appropriate conditions, these assessment systems represent an opportunity to create continuity and support more consistency in high-quality learning experiences for children, building a foundation in early settings that can be sustained continuously into the early elementary years and beyond. These systems are implemented well when the assessments encompass multiple domains of development; when the results are interpreted and used in a structured and facilitated way to support communication among practitioners and settings and to inform instruction and program improvement; and when they catalyze dialogue, cooperation, and alignment among sectors and systems to build shared expectations, standards, and practices for supporting child development and early learning. In Washington State, for example, the Washington Kindergarten Inventory of Developing Skills includes not only a whole-child assessment component but also components for family connections and for early learning collaboration to align practices among kindergarten teachers and professionals in settings prior to elementary school (Washington State Office of Superintendent of Public Instruction, n.d.).

Continuity from Year to Year in Elementary Schools

Consistency and continuity are important not only when children are entering a new setting but also from year to year and grade to grade within the same setting. An example that has received considerable attention in recent years is the discontinuity that occurs during summer breaks for elementary school students. The calendar year for most elementary schools lasts 10 months, followed by a 2-month break, which interrupts children's continuous participation in a consistent learning environment. Research indicates that students can experience a "summer loss" in achievement during this break, and this loss is greater for students with disabilities or reading difficulties and those from economically disadvantaged circumstances (Alexander et al., 2007; O'Connor et al., 2008, 2013). Year-round schooling, in which the number of school days is spread more evenly and continuously over a 12-month period, is an alternative to the 10-month calendar. Although the currently available evidence is inconclusive on whether it solves the problem of "summer loss," two meta-analyses have found that academic achievement is as good or slightly better for students in year-round schools compared with those in traditional schools and that year-round education may be particularly beneficial for students from low-income families (Cooper et al., 2003; Huebner and Educational Leadership, 2010; Worthen and Zsiray, 1994). Research also indicates that in those schools in which year-round schooling results in higher achievement, rearranging the calendar is accompanied by remediation and enrichment during breaks between sessions to help students reinforce, practice, catch up on, and apply skills or experience nonacademic enrichment (McMillen, 2001).

Coordination and Communication Across Professional Roles, Settings, and Policies

Benefits of collaboration across multiple early childhood programs and systems include not only the "bridging" function described above, but also the opportunity to provide better services to families and to share and maximize resources and training (Tout et al., 2013). Research shows that programs and services delivered with a comprehensive, coordinated approach for infants, toddlers, and their parents through preschool to primary school lead to better child outcomes (Annie E. Casey Foundation, 2013). To this end, individuals and organizations that oversee childcare and education services and programs can work together to develop a strategic and collaborative approach across the age continuum. For example, formal linkages can be established between local early childhood care and learning programs and the elementary schools the children they serve will attend (Kauerz and Coffman, 2013). Innovative approaches to encourage and support collaborative approaches will be needed, such as the coordination of funding sources (Bornfreund et al., 2014; Tout et al., 2013). Possibilities include reallocating funds, securing philanthropic partners, and blending public and private funds. Federal funds that can be leveraged include Title I, Title II, Special Education, Head Start, and the Child Care Development Block Grant (Kauerz and Coffman, 2013; Tout et al., 2013).

Although the challenge is in the implementation, the federal government does encourage some degree of collaboration among care and education programs and services through authorizing legislation, regulations, and initiatives offering federal grants. The Child Care Development Block Grant, Head Start legislation, and the Individuals with Disabilities Education Improvement Act of 2004 all include requirements for partnerships and collaboration (Tout et al., 2013). In addition, many states and local communities are employing collaborative approaches that bring together care and education professionals, such as early intervention specialists and childcare providers or school districts and community-based providers (Tout et al., 2013). Other examples of overlap and sharing also are under way: for example, special education classrooms for 3- and 4-year-olds often are part of elementary schools, and some prekindergarten programs are run by elementary schools using Title I funds.

Box 5-1 provides some illustrative examples of initiatives or approaches focused specifically on collaboration to create a more continuous system for children from birth through age 8. Note that these examples do not represent a comprehensive review of all such initiatives, nor did the committee draw conclusions about best practices or intend to endorse particular exemplars. They are included to illustrate some of the approaches that have been developed and some of the available opportunities for learning from existing efforts.

BOX 5-1

Illustrative Examples of Initiatives for Continuity Within Early Care and Education. The McKnight Foundation's Education and Learning (E&L) Program provides grants to schools around the Twin Cities to increase the percentage of children reading (more...)

Coordination with health care and other services outside of the care and education sector is discussed later in this chapter. The competencies required for these kinds of collaborations among different professional roles, referred to as interprofessional practice, are discussed further in Chapter 7.

Conclusions About the Care and Education Continuum

Consistency of high-quality learning environments and learning experiences across settings and sectors as a child ages is important to supporting development and early learning from birth through age 8. Currently, a diverse and usually uncoordinated "system" of funding streams, agencies, and organizations has responsibility or authority over services and support for young children. This fragmentation can result in inconsistent expectations for children's learning and approaches to instructional practice, lack of coordination among services for children, failure to build on learning gains, and inadequate support for children's achievement. Promoting and sustaining early gains requires better alignment and more continuous follow-through across early learning and early elementary settings, based on a developmental orientation that complements educational achievement.

Standards or guidelines for developmental milestones or achievements in early learning are most effective when age-graded expectations are accompanied by understanding of each child's developmental pace and trajectory. Standards can guide developmentally appropriate professional practice and support continuity for children if implemented with the understanding that some variability within an age span is normal as part of a continuous developmental trajectory and that children who are not at the standard milestones can be supported with high-quality and responsive instructional practices and interventions. To implement standards in this way, professionals need to be able to recognize and intervene appropriately when children are not on track and may need special help.

Children do better entering a new setting when they have certain knowledge and competencies that are the foundation of a long-range trajectory for deep and coherent learning and that help them thrive in their adjustment to a new learning environment. Expectations and standards for children at entry points into new settings are developmentally appropriate when used to reflect this understanding rather than as fixed criteria for predicting future learning success or as a threshold for advancement.

For children at entry points into new learning environments, "readiness" is not just about the competencies of the child. It is also about the competencies of educators to recognize where children are along their individual trajectories, to support children who are "ready," to help children catch up as needed in acquiring the capabilities to succeed in their adjustment, and to provide appropriate learning experiences for those children who surpass the "readiness" standard. Readiness also is about the capacity of settings and environments to support both children and educators in this work.

To support a more consistent learning experience for children, educators need to have a mutual understanding of the expectations, contexts, and instructional approaches of the settings that precede and follow their own. This understanding is particularly important when children are transitioning from one setting (such as a childcare program or preschool) to another (such as a kindergarten classroom), when the adjustments for children and risks of inconsistent expectations or instructional approaches are greatest.

CONTINUITY AMONG SECTORS

A critical factor in seamlessly supporting children from birth through age 8 is continuity among the diverse services and agencies affecting children and their families. Therefore, children need a workforce trained in supporting linkages and referrals to different sectors and systems. In addition to collaboration and coordination among professionals within sectors, connections are necessary among professionals across sectors, including information and data sharing, handoffs, referrals, case management, and shared professional learning (see Figure 5-2). Coordination with health care, social services, and other services can help ensure that all children receive comprehensive care that addresses the many factors affecting their well-being, that children's early experiences contribute consistently to developmental achievements, and that all professions who work with young children have a shared understanding of the interconnected quality of developmental processes that each may see only in part.

FIGURE 5-2

Activities that contribute to connections among professional roles across sectors.

Some of the important connections include screening, consultation, and referral from care and education to specialized education services, as well as health, mental health, and social services such as

general well-child health services;
health screening (e.g., hearing, vision);
mental health services;
nutrition support services;
services for children with disabilities and other special needs;
screening and services to recognize and address child neglect and abuse; and
support services that facilitate the ability of families to provide a safe and healthy environment for their children, including policies and programs designed to increase resources for disadvantaged and low-income families (e.g., Medicaid, work support policies, the Supplemental Nutrition Assistance Program, cash transfer programs).

Linkages and connections among sectors can take various forms. One form is coordination at the level of policy alignment, shared planning, and coordination among different systems/sectors. For example, states can improve planning and coordination to ensure that children with special needs receive all needed services across sectors and continuously as they move between settings and service delivery systems (Annie E. Casey Foundation, 2013). Another approach is collocation of various services for children such that physical proximity becomes a means of facilitating interprofessional relationships and collaboration. For example, a model of coordination between health care and Head Start entails providing educational programs and delivering health care services in the same setting. Several states have initiated similar programs that support communities in linking health care and family services through early learning programs; these programs have been effective in reducing nonfinancial barriers to accessing health and mental health services (Tout et al., 2013). Other approaches include community-level service and program collaboration and coordination to build structural relationships among organizations; implementation of referral and tracking systems; and the use of professionals with a specific role as a coordinator/case manager/navigator among services.

Box 5-2 provides some additional illustrative examples of initiatives or approaches specifically focused on improving linkages, collaboration, and continuity between care and education and other sectors that provide important services for children and families. In keeping with the scope of this report as described in Chapter 1, the focus of these examples is on connecting health, education, and social services. As with Box 5-1, these examples do not represent a comprehensive review of all such initiatives, nor did the committee draw conclusions about best practices or intend to endorse particular exemplars. Of particular note, in light of the focus of this report, is that there is little documentation or evaluation of changes to practitioners' scope of work, roles, and responsibilities; specific new required competencies; and training and other professional learning activities associated with the implementation of these approaches. Nonetheless, these examples illustrate some conceptually sound approaches that are being implemented and offer the opportunity to learn from existing efforts.

BOX 5-2

Illustrative Examples of Initiatives for Linkage and Collaboration Among Sectors. The Promise Neighborhoods program creates a "cradle-to-career" continuum by increasing supports within the family, the community, and education systems. (more...)

The competencies required for these kinds of collaborations among different professional roles, referred to as interprofessional practice, are discussed further in Chapter 7.

Another approach for improving linkages across sectors entails not just focusing on making systems changes and expanding the scope of practice of current practitioners to improve coordination, which can be difficult for already overburdened practitioners, but introducing a professional role specifically responsible for coordination among services. This individual manages and coordinates the service needs of children and families and facilitates communication among service providers and between service providers and families.

A wide range of such models have been established in the medical and education fields. The title of the individual varies with the specific model, including patient navigator, case manager, community health worker, home/school coordinator, and family service coordinator, among others. The responsibilities of these individuals include

facilitating communication between families/patients and professionals in various sectors, including schools;
removing barriers by assisting with logistical tasks (e.g., transportation issues, making appointments);
helping to negotiate expectations between families and professionals; and
using individual case management to establish partnerships with families in the areas of health and social services.

In the education field, Allen and colleagues (1996) describe the role of family service coordinators as helping families navigate services for children in different sectors, including social services, education, health, and nutrition. Acting as advocates for children and families, family service coordinators connect families with these services, which can result in higher levels of family engagement and parents' involvement in their child's education and health. Children may receive direct benefits from navigation services, including regular medical and dental care, as well as follow-up care and healthy snacks in schools. Parents also receive direct benefits, including a parental support network, resources to help them work with their children, and strengthened communication with professionals, which can all empower parents to participate actively in their child's development. Coordinators also work with families to identify individual needs, which helps establish a trusting relationship (Allen et al., 1996).

The state of Kentucky, for example, established a family service coordinator system through the Kentucky Education Reform Act of 1990. This program provides connections between families and social and health services in an effort to ensure that all children have access to care. An 18-month study of this program showed that the system emphasized finding solutions to problems as well as establishing thorough and clear communication of expectations between families and professionals working with children (Smrekar, 1996).

Currently, Part C of the Individuals with Disabilities Education Act includes an Individualized Family Service Plan (Sec. 636) through which a multidisciplinary team collaborates with parents to develop a written individualized plan for infants and toddlers with disabilities and their families. This plan focuses on physical, cognitive, communication, social, emotional, and adaptive development; considers family resources and priorities; and details interventions and expected measurable outcomes. A service coordinator is responsible for implementing the plan, as well as facilitating coordination with other services that are relevant to the needs of the infant or toddler and family members (U.S. Department of Education, 2015).

The approach of introducing a specific role for coordination of services can be informed by similar professional roles that have evolved in the health field to help patients navigate access to care and other services. For example, a "barrier-focused intervention" model includes removing instrumental and relationship barriers. Services of an intervention might include transportation assistance for appointments and other logistical tasks and building and strengthening relationships and communication between patients and providers. Given that the needs of different populations vary, the role of the patient navigator includes assessing the population's needs and adapting the intervention services to meet those needs. For example, navigators work with cancer patients to help remove logistical and communication barriers while facilitating their relationships with physicians. Studies have shown increased screening rates at the population level associated with patient navigation services, with a limited effect on followup diagnostic services and treatment. Patients express a strong desire to continue receiving navigation services through the course of their services (Paskett et al., 2011).

Another model is illustrated by Project Access Dallas, which works with community health workers who provide navigation services to those who experience barriers to health care (Gimpel et al., 2010). Community participants in this program indicated that they became comfortable working with their community health worker and asking questions, both medical and nonmedical. Many participants also indicated that through the navigation services, they became independent and acquired the ability to manage their own health care with dignity. This work also helped establish relationships and strengthen social networks within communities (Gimpel et al., 2010). Other examples of navigator models work to manage communication between service providers (formal and informal services and support systems) and individuals with intellectual disabilities (Bigby et al., 2007). Because individuals with disabilities may encounter barriers to accessing services, an effective patient navigator can inform service providers about the needs of individual participants to ensure that services are inclusive of all who need them (Bigby et al., 2007).

Conclusions About Continuity Among Sectors

Child development is highly interactive across different domains, including those supported by professionals not only in care and education but also in other sectors, especially health, mental health, family support, and social services. Yet in the complex landscape of settings and systems for children and families, there are gaps and weaknesses in referral and linkage when children and families need to be connected to services across sectors:

Some of these gaps relate to the workforce in the related sectors, including insufficient availability of or access to referred services (such as home visiting, pediatric health services, early intervention services, and mental health consultation and services).

Other gaps relate to the knowledge and competencies of the workforce: lack of skills for screening and assessing a child's status and needs, lack of knowledge about available services, and lack of skills for interprovider communication and collaboration.

These gaps highlight the need for the workforce across sectors that serve young children to incorporate interprofessional practice and collaboration as a core competency.

The responsibility and burden of improving coordination and collaboration cannot rest solely on individual practitioners. Systems barriers need to be removed and facilitative supports put in place to improve communication and interaction among professional roles. In addition, the use of professionals with the primary role of facilitating coordination among services for children, families, and practitioners needs to be enhanced.

REFERENCES

Alexander KL, Entwisle DR, Olson LS. Lasting consequences of the summer learning gap. American Sociological Review. 2007;72(2):167–180.
Allen SM, Thompson R, Drapeaux J. Providing Head Start-like services from kindergarten through the third grade: The role of family service coordinators; Paper presented at Head Start National Research Conference, 3rd; June 20-23; Washington, DC. 1996.
Annie E.Casey Foundation. The first eight years: Giving kids a foundation for lifetime success. Baltimore, MD: Annie E. Casey Foundation; 2013.
Barnett WS, Carolan ME, Fitzgerald J, Squires JH. The state of preschool 2012: State preschool yearbook. New Brunswick, NJ: National Institute for Early Education Research; 2012.
Bigby C, Fyffe C, Ozanne E. Planning and support for people with intellectual disabilities: Issue for case managers and other professionals. London: Jessica Kingsley; 2007.
Bornfreund LA, McCann C, Williams C, Guernsey L. Beyond subprime learning: Accelerating progress in early education. Washington, DC: New America Foundation; 2014.
Clements DH. Computers in early childhood mathematics. Contemporary Issues in Early Childhood. 2002;3(2):160.
Clements DH, DiBiase A-M, Sarama J. Engaging young children in mathematics: Standards for early childhood mathematics education. Studies in mathematical thinking and learning series. Mahwah, NJ: Lawrence Erlbaum Associates; 2004.
Cooper H, Valentine JC, Chalton K, Melson A. The effects of modified school calendars on student achievement and on school and community attitudes. Review of Educational Research. 2003;73(1):1–52.
Daily S, Burkhauser M, Halle T. A review of school readiness practices in the states: Early learning guidelines and assessments. Child Trends Early Childhood Highlights. 2010;1(3):1–12.
Dmitrieva J, Steinberg L, Belsky J. Child-care history, classroom composition, and children's functioning in kindergarten. PSCI Psychological Science. 2007;18(12):1032–1039. [PubMed: 18031408]
Gebhard B. Putting standards into practice: States' use of early learning guidelines for infants and toddlers. Washington, DC: Zero to Three; 2010.
Gimpel N, Marcee A, Kennedy K, Walton J, Lee S, DeHaven MJ. Patient perceptions of a community-based care coordination system. Health Promotion Practice. 2010;11(2):173–181. [PubMed: 19131540]
Graves B. PK-3: What is it and how do we know it works? New York: Foundation for Child Development; 2006.
Kagan SL, Scott-Little C. Early learning standards: Changing the parlance and practice of early childhood education? Phi Delta Kappan. 2004;85(5):388–396.
Kagan SL, Moore E, Bredekamp S. Reconsidering children's early development and learning: Toward common views and vocabulary. Washington, DC: National Education Goals Panel; 1995.
Kauerz K, Coffman J. Framework for planning, implementing, and evaluating preK-3rd grade approaches. Seattle: University of Washington, College of Education; 2013.
McMillen BJ. A statewide evaluation of academic achievement in year-round schools. Journal of Education Research. 2001;95(2):67–74.
NAEYC-NAECS/SDE (National Association for the Education of Young Children-National Association of Early Childhood Specialists/State Departments of Education). Position statement: Early learning guidelines. 2002. [November 3, 2014]. http://www.naeyc.org/files/naeyc/file/positions/position_statement.pdf.
NEGP (National Education Goals Panel). Reconsidering children's early development and learning: Toward common views and vocabulary. Washington, DC: NEGP; 1995.
NRC (National Research Council). Early childhood assessment: Why, what, and how. Snow CE, Van Hemel SB, editors. Washington, DC: The National Academies Press; 2008.
O'Connor RE, Bocian KM, Beebe-Frankenberger M, Linklater DL. Responsiveness of students with language difficulties to early intervention in reading. Journal of Special Education. 2008;43(4):220–235.
O'Connor RE, Bocian KM, Beach KD, Sanchez V, Flynn LJ. Special education in a 4-year response to intervention (RTI) environment: Characteristics of students with learning disability and grade of identification. Learning Disabilities Research and Practice. 2013;28(3):98–112.
Paskett ED, Harrop JP, Wells KJ. Patient navigation: An update on the state of the science. CA: A Cancer Journal for Clinicians. 2011;61(4):237–249. [PMC free article: PMC3623288] [PubMed: 21659419]
Pianta RC, Cox MJ, Taylor L, Early D. Kindergarten teachers' practices related to the transition to school: Results of a national survey. Elementary School Journal. 1999;100(1):71–86.
Sadowski M. Core knowledge for PK-3 teaching: Ten components of effective instruction. New York: Foundation for Child Development; 2006.
Sajaniemi N, Suhonen E, Kontu E, Rantanen P, Lindholm H, Hyttinen S, Hirvonen A. Children's cortisol patterns and the quality of the early learning environment. European Early Childhood Education Research Journal. 2011;19(1):45–62.
Schulting AB, Malone PS, Dodge KA. The effect of school-based kindergarten transition policies and practices on child academic outcomes. Developmental Psychology. 2005;41(6):860–871. [PMC free article: PMC2757260] [PubMed: 16351333]
Scott-Little C, Lesko J, Martella J, Milburn P. Early learning standards: Results from a national survey to document trends in state-level policies and practices. Early Childhood Research and Practice. 2007;9(1)
Scott-Little C, Kagan SL, Frelow VS, Reid J. Inside the content of infant–toddler early learning guidelines: Results from analyses, issues to consider, and recommendations. Greensboro, NC: University of North Carolina at Greensboro, Department of Human Development and Family Studies; 2008.
Shepard LA, Kagan SL, Wurtz E. Principles and recommendations for early childhood assessments. Washington, DC: National Education Goals Panel; 1998.
Smrekar C. The influence of the family services coordinator on family–school interactions in school-linked social service programs. Elementary School Journal. 1996;96(4):453–467.
SRI (SRI International) and CAREI (Center for Applied Research and Educational Improvement). The McKnight Foundation Education and Learning Program: PreK–third grade literacy and alignment formative evaluation findings. 2013. [December 19, 2014]. https://www.mcknight.org/system/asset/document/454/ELEvalBriefs_10_14_13.pdf.
Tout K, Halle T, Daily S, Albertson-Junkans L, Moodie S. The research base for a birth through age eight state policy framework. Washington, DC: Alliance for Early Success and Child Trends; 2013.
U.S. Department of Education. IDEA 2004: Building the legacy, part C (birth-2 years old). 2015. [February 18, 2015]. http://idea.ed.gov/part-c/statutes.
Washington State Office of Superintendent of Public Instruction. Washington Kindergarten Inventory of Developing Skills (WaKIDS). n.d. [March 6, 2015]. http://www.k12.wa.us/wakids.
Wat A. Aligning and implementing birth-3rd grade learning standards. Philadelphia, PA: National Governors Association Policy Forum; 2013.
Watamura SE, Donzella B, Alwin J, Gunnar MR. Morning-to-afternon increases in cortisol concentrations for infants and toddlers at child care: Age differences and behavioral correlates. Child Development. 2003;74(4):1006–1020. [PubMed: 12938695]
Worthen BR, Zsiray SW. What twenty years of educational studies reveal about year-round education. Chapel Hill, NC: North Carolina Educational Policy Research Center; 1994.
Zaslow M, Halle T. Purposeful early childhood assessment; Paper read at Child Care Policy Research Consortium; October 29; Washington, DC. 2009.

noyestheance.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/books/NBK310544/