Whether it is preparing an older sibling for the arrival of a new baby or potty training a toddler, Camille Carlson recognizes that everyone – whether they are aware of it or not – uses Continuous Quality Improvement (CQI) to improve everyday life. CQI is an invaluable reminder of the strength found in taking small, intentional steps. Therefore, it is important to break up the process into achievable goals – and celebrate the milestones along the way!

As Start Early Washington’s Quality Improvement and Innovation Manager, Camille Carlson’s approach to Continuous Quality Improvement (CQI) is instrumental in supporting home visiting services statewide. Through individual and group coaching, Camille guides professionals in the field toward providing the best possible services for children and families using tools to identify and test changes on a small scale. Together with CQI teams and Washington home visiting programs, Camille works to identify changes that result in significant improvements for the home visiting field, families and children, all part of Start Early Washington’s mission to create strong foundations necessary for more fulfilling work that continuously improves supports and resources available to families statewide.

A Beautiful Reminder

Camille uses her expertise to help home visiting programs deliver services relevant to the unique needs of the children and families they support. Her firsthand experience as a parent fuels her desire to improve systems of support for children, their families, and the teams of staff that serve them. Camille’s motivation for this work grew when she was pregnant with her second child. “During my pregnancy, I had the support of home visitors and supervisors at my fingertips. As I listened to home visiting professionals across the state discuss parent coaching and family observations, I started applying their valuable insight to navigate the changing dynamics of my life with two children. This process helped me gain confidence in my parenting skills, and it was a beautiful reminder that family is central to our work. I was overwhelmed by the support that was given to me and the confidence that it brought, which emphasized the importance of sharing such a positive experience with others.”

It's easy to get lost in big goals. If you focus on small steps, you feel like you are progressing toward your goal and more likely to sustain your gains while addressing other things.

— Camille
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Connecting Data to Practice

Quality improvement is essential to providing successful home visiting services where staff collaboratively establish goals, reflect and create actionable steps for improvement. By adhering to a CQI process, home visiting programs can build strong relationships with families, make well-planned decisions and increase positive outcomes to achieve better support for children and families.

The ongoing, collaborative process draws on the expertise and experience of home visitors, supervisors, community partners and families. Although data points are a big part of CQI, Start Early Washington works toward cultivating a culture of continuous quality improvement rather than another set of requirements to check off for reports. “Since I’ve been in my role, we have seen an investment in a CQI culture. Teams have grown significantly, and we are beginning to see a sense of buy-in and excitement around the process.”

Camille shared her immense gratitude for the opportunity to work with and coach organizations that provide home visiting services to families across Washington state with the shared goal of creating positive change for the organizations and families that they serve, utilizing a CQI lens.

CQI tools support home visiting programs through activities and benefits such as:

  • Individual coaching and consultation for home visiting programs that guides problem-level improvement projects and supports data analysis or reporting
  • Group learning offers programs the opportunity to share and reflect on future improvement strategies
  • Facilitation and liaising with national CQI resources and initiatives

Over time, our goal is to develop meaningful partnerships with programs and families to improve systems of support and lifelong outcomes. Meaningful relationships can be fostered throughout the stages of quality engagement, all while building confidence and trust between providers and families as they work toward a common goal.

Explore more about Washington’s home visiting work and strategic tools.

As the program analyst for Start Early Washington, Anna Contreras is always thinking about what works best to support the children and families that participate in Washington’s home visiting programs. She collects and analyzes a mixture of quantitative raw data as well as the often-overlooked qualitative feedback needed to truly improve and enrich the home visiting experience for children and families. This includes collating information gathered from numerous home visiting professionals across the state.

Anna has dedicated her professional career to understanding how relationship-based supports impact lifelong outcomes for young children and their families. She’s particularly interested in families grappling with adversities, such as migrant and seasonal farmworkers, immigrant communities and dual language learners. “My Latinx background not only identifies me but defines me. As a second-generation immigrant, I relate to the challenges of those who are growing and learning from their native culture while also adjusting to new societal norms and navigating American culture.”

Anna and her mother reading together
Anna (7 yrs) and her mom love to read books from their local library.

Anna’s commitment to improving the home visiting experience and creating more equitable and inclusive systems that recognize and respect diversity begins with her mother. Home visiting has been part of Anna’s life since the day she was born. Anna’s mother received home visiting services in Washington state when she was pregnant with Anna, a support that was not provided for Anna’s siblings. Because of this experience, her mother was better connected to her community’s resources and felt more comfortable talking through the various roadblocks she was experiencing. In addition, her home visitor helped her better understand the services and supports available to her. They were a trusted partner to nurture and support Anna’s healthy development. This was especially important to Anna’s mother because she didn’t have her mom (Anna’s abuela) near at the time.

Recalling her personal experiences and her experience helping her parents navigate data collection and other complex information, Anna finds it essential to create inclusive forms and dashboards for the home visiting support team.

“I always ask, what would make the most sense for the person using this tool? Interpretation is everchanging, and you must make space to understand where others are coming from.” — Anna

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Anna also shared the importance of considering the impact on the person collecting information. “When creating forms, we consider the impact on the staff asking the questions — such as, what does the answer mean for the respondent? How is this information going to be utilized? What are the unintended consequences for the person sharing the information? People must feel comfortable enough to share this information. They also want to ensure that necessary changes will follow and that they are not wasting their time answering another set of questions; it is hard to be vulnerable, especially when you are unsure of what will happen next with the information provided.”

Whether it’s a first-time parent connecting with a home visitor or staff sharing their experiences with each other, trust and respect are vital to collecting meaningful information. Relationship-building is foundational to Start Early Washington’s work and a key ingredient to affecting meaningful change.

“As a first-generation college student, relationship-building was important to me. Feeling seen and heard was fundamental to my growth and development, and therefore I carry that experience in my work today.” Feeling accepted, safe and connected to a community of support helped push Anna past moments of self-doubt and projected her toward future success in her home life, career and beyond.

The Subtle Differences

Data showcasing the subtle differences in home visiting provider experiences and the depth of variation between the family dynamics they support helps inform the resources and learning opportunities needed for the home visiting field as well as the various elements required to support the children and families they partner with. In addition, such data-driven insights are vital to maintaining an inclusive and collaborative decision-making process for system improvements.

Anna primarily works with Start Early Washington’s home visiting team to improve home visiting services and outcomes for children and their families in Washington state. Anna works closely with the home visiting team to assess customized coaching and mentoring offered to home visiting programs. Similarly, she evaluates how Start Early Washington can best support comprehensive learning opportunities, transparent data collection and thoughtful analysis.

For example, surveys are designed to answer questions such as: Does the home visiting field have the professional development opportunities they need to grow their skills? What additional support is needed for home visitors to feel confident in their role? How can Start Early Washington help home visiting professionals achieve individual and programmatic goals? These questions and more help to ultimately measure how we can support positive system changes —such as gains in knowledge, better time management, improved staff retention and the creation of better family engagement protocols.

Qualitative feedback helps Anna understand the story of home visiting in our state, connecting the necessary data points to improve system outcomes and inform policymakers. Data allows us to see how and when priorities shift for programs, and feedback and discussion help us understand what success and challenges look like for home visiting programs and the families they work with. Qualitative feedback from our home visiting team helps uncover trends in discussions, typically hidden among quantitative numbers alone. This data complements ongoing performance monitoring to ensure continuous quality improvement for home visiting professionals statewide.

Anna’s work strengthens home visiting programs by showcasing the power of relationship-based work, reinforcing the deep connections and trust between home visitors and families. Recognizing the unique identities, heritages, cultures and human emotions while celebrating differences and bolstering representation validates and supports an environment of inclusion for the entire home visiting system.

Trust Is Pivotal

While data is critical to support a high-quality system, trust is pivotal to accessing quality information and rich feedback. Some things for home visiting teams to consider when collecting data:

  • Use simplified language; the frame of information is important.
  • Are questions clear enough to capture the needed information?
  • Do all parties understand how the data collected will inform the home visiting system?
  • Does the reader understand their rights and role in responding to the questions?

Co-Creative Learning Opportunities for Home Visiting Professionals

Start Early Washington facilitates learning opportunities as well as unstructured co-creative opportunities for home visiting professionals statewide to build knowledge, seek mentorship, connect and decompress with others in the field experiencing similar situations. Together, they work through obstacles and celebrate successes; since 2020, Start Early Washington’s work has reached nearly 8,235 children and families. Our approach to supporting the home visiting field includes mindfulness practices, reflection, sharing experiences and knowledge that builds trust in a strengths-based learning environment.

A growing concern for the early childhood field is how to best support parents and families in nurturing their young children’s healthy development. Educators and leaders are eager to help families gain the knowledge and tools they need to effectively engage in their children’s learning.

Technology-based interventions hold great promise for reaching and communicating with families. These interventions are relatively low-cost, scalable, and accessible for parents who use their mobile phones for communication and information seeking. Technology-based interventions can also reinforce the learning and community building of on-the-ground family support programs. But this promise can only hold true if the technology products are designed to reach parents and communicate what they want to know.

In the last few years, a number of tech-based family engagement platforms and tools designed to guide parents have emerged, including apps like Vroom, Let’s Play, and Kinedu, video tools like Ready Rosie, texting programs such as Text4Baby and Ready4K, podcasts, and word-tracking wearables like LENA and Starling. As awareness about early childhood development increases, more technology players (non-profit and for-profit) are likely to enter this space.

At The Early Learning Lab (The Lab), we have spent the past year surveying early childhood technology tools, learning how various products and programs are being implemented and evaluated, and identifying best technology practices for early childhood family engagement.

Whether you are an entrepreneur developing a new early learning tech product, a school administrator trying to find an effective family-engagement tool, or a parent-support program operator looking to add a digital component to your program, The Lab sees the following 10 design elements as critical to the impact of any early learning parent engagement tool:

10 Critical Design Elements for Parent Engagement Technology

  1. Research-based: The early learning research community has built a solid body of evidence on the neuroscience of developing minds and the practices that support early learning, health, and development. For example, the Center on the Developing Child out of Harvard has a wealth of research on developing executive functioning skills in children; the torch that Hart and Risely lit on the word gap is carried by researchers such as Dana Suskind; the Yale Center for Emotional Intelligence has developed a body of work around developing emotional intelligence in children. Any technology tool worth developing or investing in should be research-based. Moreover, an affiliation with researchers is a good sign that the developers are serious about improving outcomes for children. A good example is the app Vroom, which was developed in collaboration with a bevy of early childhood researchers.
  2. Has an Evaluation Strategy: Often, when developing commercial technology tools, the only success metric that counts for developers (and their investors) is the number of users. In the social sector, revenue isn’t good enough – we have to demonstrate impact. Developers that are serious about improving child outcomes will have an evaluation strategy. They will articulate a theory of change and the tool’s intended impact; they will have clear measures to evaluate it. They will be transparent about the data they collect and have a strategy to iterate on their model if they are not having the desired impact.
  3. Co-designed: Parenting is a highly personal pursuit and emotionally-charged issue that often reflects differences in culture, class, and values. The early childhood field has stumbled when trying to prescribe practices to parents in a top-down manner that does not take into account the realities parents face. Products and programs must be co-designed with parents, and this means going beyond focus groups and informational interviews. Parents should not only be part of defining the problem, they should be part of developing the solution. This means partnering with parents to identify the impact the tool should have as well as the success measures used. Parents should also participate in the design and testing of the product.
  4. Accessible: Accessibility is key to any technology product, but the importance is magnified when developing technology for social change. The key is to know your audience, and make sure that what you are developing can actually be used by the people you want to reach. With technology created for parent engagement consider the following:
    1. Language: Is your tool accessible to people who speak languages other than English?
    2. Literacy Level: Are there content pathways in your tool for people with low levels of literacy?
    3. Cost: Is your tool affordable? If it is mobile-based, does it require the use of data plans that may be too costly for your target audience?
    4. Platform: Where are your users? Go to them, don’t make them come to you. Chances are, asking people to download an app or purchase new hardware or software will create a barrier that you will have to overcome for product adoption.
    5. Ease-of-use: Obviously, user experience and user interface design are huge considerations when developing a technology product, but also consider how your tool fits into the lives of your audience. Does it require a daily or weekly time commitment? Can content be consumed in pieces, or does the user have to set a considerable amount of time aside to interact with your tool? Many texting programs, such as Stanford’s Ready4K! are based in part on the theory from behavioral science that small “nudges” of information are more effective in supporting new behaviors than large amounts of information delivered at once.
  5. Puts Data in the Hands of the User: One of the most exciting aspects of technology is that it allows for the gathering, processing, and delivery of information quickly. But who gets to see the data is an important consideration.At The Lab, we are firm believers that users should have access to their own data (or in the case of parent engagement, parents should have access to data on their children). For example, tools such as LENA and the Starling allow parents to track the number of words their child hears over the course of the day. User feedback on these tools suggest that their effectiveness is at least partially due to the empowerment that results from access to this data. (Parents can see the effect of their actions in increasing the number of words their children hear, a recognized metric for fostering early learning.)
  6. Builds Community: Technology is often denigrated for its role in decreasing personal connections, but it can also be a powerful connector. After all, communication and connection are at the heart of many technologies, from email to Facebook, which create bridges based on shared interest across geographies.When developing or evaluating a technology for family engagement, think about how that tool can create connections among users and build their social capital. The LENA Research Foundation developed a program called LENA Start to help community-based organizations and schools conduct group trainings for parents on using LENA at home with their children. Not only did parents learn about the tool, they benefitted from connecting with each other by sharing tips and experiences about the trials and tribulations of raising a young child.Similarly, the website Understood has a robust online community that connects parents of children with learning and attention issues, a group that sometimes feels stigmatized in their offline communities and schools.
  7. Accommodates Two-Way and Peer-to-Peer Communication: Users are no longer just consumers of content, they’re creators of it. A smart developer will solicit user-generated feedback to understand how the tool is being used, what’s working and what’s not.Smart tools will also let users connect with other users to share their own content. Ready Rosie is a program that delivers videos to parents, modeling fun learning activities they can do with their children. The Ready Rosie team found that some of their users were eager to share their own learning activities with the Ready Rosie community, so the team has incorporated those activities into the official Ready Rosie curriculum.
  8. Incorporates Rapid Feedback Cycles: Waterfall is out, agile is in, and modern technology development is all about rapid cycle feedback. Any product worth investing in should be on a continuous improvement path. Strong developers will monitor usage data frequently to quickly incorporate user feedback in iterations of their product. Success metrics should be tracked to determine if the product is meeting its stated goals, and the developers should have a plan in place to adjust the product roadmap if it is not.
  9. Builds User Self-Efficacy: Parents are the experts on their children. Most instinctively know what they need to do to support their children’s healthy development. Our role should be to 1) fill in knowledge gaps where they exist by giving parents information on the high-value practices they should be doing with their children; 2) ensure parents have enough knowledge of child development and their role in supporting their child’s growth over time. The goal is to help parents build their own parenting muscles and see the beneficial effects they have on their children. Rather than keeping parents dependent on experts every step of the way, technology should help parents become strong advocates for their children’s learning and academic success.
  10. Embedded in Existing Systems: Technology products, embedded in the systems in which parents are already interacting (their local school district, their local library, an existing home visitation program), have the best chance of gaining parents’ attention. Rather than going straight to consumers, Ready4K partners with school districts to register the families of incoming students for their texting program. BringingUp, from the creators of Ready Rosie, allows teachers to send videos to their families to help build the school-home connection while also fostering early learning at home. A dashboard allows teachers to track which of their families are viewing the videos. Texting programs like Talk, Read, Sing partner with media outlets such as Univision to reach parents who might not otherwise hear about the program. Embedding products into existing delivery channels make user acquisition easier, and make it easier on families who may already be feeling pulled in too many directions.

All in all, no one product is going to have all 10 of these elements. But this list can serve as a useful guide for developers and a wish list for people who are evaluating and purchasing technology products for parent engagement. Technology holds great promise for reaching large numbers of families and helping us achieve the goal of kindergarten readiness for all, but only if the products we develop and use are designed for impact.

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