Methodology: In order to address the research questions, 29 in-depth, semi-structured interviews were conducted with key community stakeholders representing various sectors that impact vulnerable families with young children. The interviews lasted 60-90 minutes and were with a non-random convenience sample. Using snowball sampling methods, the research team also asked identified stakeholders to recommend others that could provide novel data, and sought input from community partners to ensure a wide and representative sample. Content analysis of the interviews was used to explore content themes and to guide the development of the framework. Member checking strategies were utilized to add rigor to the analysis.
Results: The analysis contributed to a cross-sector framework with six key areas of opportunity for accessing and engaging families to prevent the exposure of significant adversity and building resilience. The key areas identified are: Basic Needs (healthcare, quality food, transportation, employment and housing), Neighborhood Climate and Community Norms (social connections, communal spaces, safe and violence free neighborhoods, and racial and ethnic equity), Prenatal and Birth (family planning, preparation for caregiving, trauma-informed prenatal care, screening and education around ACEs), Parenting Programs and Wellness (trauma-informed and evidence-based supports, promotion of parent-child attachment, emphasis on prevention, use of technology to engage), Pediatric Well-Checks (knowledge and tools to address social determinants of health, trauma-informed practice), and Quality Childcare (strong school-community partnerships, access to high quality childcare and universal preK, social-emotional development). Findings also demonstrate need for cross-sector approaches beyond traditional targeting of at-risk families, the importance of universal strategies, and the need to expand efforts to build community resilience.
Conclusion and implications: While the knowledge base about the impact of significant childhood adversity is growing, additional research is needed to develop approaches to translate the evidence to practice. The comprehensive framework demonstrates that collaboration and education is needed across multiple sectors in order to reach vulnerable children and families prior to entering kindergarten. Rather than relying on the traditional approach of identifying and targeting at-risk families, focus should also include universal approaches that look at a wide continuum of supports including additional resources to support basic needs, public education efforts to change social norms and behavior in caregiving, increased social connectedness and support, healthcare with tools to address social determinants of health, neighborhood activities that engage parents, and public policies that support all children and families.