Change Package for Community Health Centers: Integrating the Early Childhood Development Continuum of Care
Early childhood development (ECD) lays the foundation of lifelong health, learning, well-being, and success. The earliest years of life are a critical window for supporting healthy brain development, strong relationships, and positive health outcomes. Community health centers play an essential role in helping children and families thrive. By providing comprehensive, family-centered care, health centers support children’s physical health, development, and social-emotional well-being while helping families connect to the services they need.
This change package provides an evidence-informed collection of actionable ideas to help health centers integrate the ECD Continuum of Care, focusing on strengthening promotion and prevention, surveillance and screening, care coordination and linkage, and early intervention services. Together, these approaches support coordinated, family-driven care for children from conception to age 5, connecting health care with education and social services when families need them.
Click the yellow buttons to access the change ideas. This introduction page also includes several sections to help your health center or practice use the change package:
- Important Role of Community Health Centers in Supporting ECD
- About the Change Package
- Key Driver Diagram for Integrating the ECD Continuum of Care
- How to Use the Change Package as Part of a Continuous Quality Improvement Project
- How to Select and Test Change Ideas
- Quality Improvement Readiness Checklist and Prioritization Table for ECD Change Ideas
Access the change ideas, organized into the four parts of the ECD Continuum of Care:
Use the Key Driver Diagram to map your pathway across the change package and Quality Improvement Readiness Checklist to identify where to begin.
Important Role of Community Health Centers in Supporting ECD
During the first 5 years of life, children experience rapid brain, emotional, and physical development that shapes future health and success. Community health centers are uniquely positioned to reach the needs of all families early and consistently. Because they serve families across generations and communities, health centers can identify developmental concerns early, provide guidance to caregivers, and connect families to services that strengthen their children’s health and development.
When ECD support is embedded into routine pediatric care, community health centers can identify developmental concerns earlier, strengthen relationships with families, connect families to timely supports and services, and promote healthy development for all children. This change package helps community health centers turn those priorities into practice.
About the Change Package
This change package was developed as a practical resource for community health centers working to improve ECD outcomes. It includes the following components:
- Key driver diagram: A visual tool used in quality improvement to map the pathway toward achieving a specific goal.
- Aims: Desired outcomes that are specific, measurable, achievable, relevant, and time-bound.
- Primary drivers: High-level system components that influence progress toward the aim.
- Change ideas: Evidence-based actions, promising practices, or innovative approaches that help improve each driver.
- Sample tools: Practical resources such as workflows, checklists, templates, and examples that support change ideas.
Each change idea outlines practical steps that teams can test and adapt in their own settings to strengthen promotion and prevention, surveillance and screening, care coordination and linkage, and early intervention. The change package also includes adaptable sample scripts, checklists, planning guides, and curated training resources designed to support busy health centers in implementing and testing improvements.
Teams are encouraged to test small changes, learn from the results, and adapt approaches to meet the needs of the families and communities they serve.
Note on Adaptation: All examples provided throughout the change package are illustrative. Health centers should adapt these ideas to align with their local context, ethical guidelines, and organizational policies.
Key Driver Diagram for Integrating the ECD Continuum of Care
This key driver diagram helps teams understand how different parts of the system work together to improve outcomes.
How to Use the Change Package as Part of a Quality Improvement Project
This change package is designed to support practical, ongoing improvement efforts in ECD care. Health centers can test and adopt these ideas using quality improvement (QI) methods that fit into everyday clinical practice. QI is a structured way to improve health outcomes by testing changes, learning from results, and refining approaches over time. Using a QI approach allows community health centers to adapt change ideas to the needs of their communities while aligning with best practices in pediatric primary care.
Teams can begin by selecting one change idea and testing it on a small care – for example, with one provider, one well-child visit, or a small group of families. Based on feedback and results, teams can refine the process before expanding successful changes across providers, clinics, or patient populations. Each change idea in this package includes step-by-step guidance organized into five improvement stages.
In this step, the health center identifies a specific area for improvement, such as strengthening development surveillance, improving referral follow-up, or enhancing family engagement. A cross-functional team is formed, including clinical staff, administrative staff, and community and family representatives. The team gathers baseline information and ensures alignment with organizational priorities and family needs.
Key Actions:
– Define the QI focus (e.g., family-engaged developmental surveillance, identifying community partners for care coordination, introducing brief interventions with an integrated early childhood expert).
– Form an improvement team with staff and community voices.
– Collect baseline information to understand the current workflow.
– Confirm leadership support and alignment with health center priorities.
Once a focus area is identified, the team designs a small test of change. The goal is to try a new approach in a controlled way before expanding it more broadly. For example, a team might test a new script for introducing referrals, pilot a developmental guidance tool, or test a new screening workflow with one provider.
Key Actions:
– Generate change ideas based on data, staff input, and family feedback.
– Select a change to test in a small setting (e.g., one provider, 1 week).
– Outline a simple plan describing who will do what and when.
– Run the test and gather feedback or basic data.
After the test, the team reviews what happened and reflects on the results. Did the change improve the process? What worked well? What barriers were encountered? Teams analyze data, gather staff and family feedback, and determine whether the change should be modified, tested again, or expanded.
Key Actions:
– Review what happened during the test.
– Examine data, observations, and team experiences.
– Identify successes and barriers.
– Modify the plan for further testing or improvement.
If the change proves successful, the health center can expand it to other providers, departments, or clinics. This step focuses on training others, adjusting for different settings, and maintaining quality as the effort grows.
Key Actions:
– Develop a plan to roll out the change more broadly.
– Provide training and support for new staff involved in the process.
– Monitor implementation to ensure consistency and effectiveness.
– Adapt workflows for new settings while preserving core elements.
To ensure improvements last, the team integrates successful changes into standard policies, workflows, and training processes. Ongoing data monitoring and team check-ins help maintain progress and allow the health center to continue improving care over time.
Key Actions:
– Update protocols, workflows, and documentation.
– Establish routine monitoring to track long-term impact.
– Celebrate successes and recognize team contributions.
– Foster a culture of continuous improvement and learning.
How to Select and Test Change Ideas
Health centers may begin their improvement work in different places. Some may already conduct developmental screenings but want to strengthen follow-up and referrals. Others may be working to expand family engagement or hire early childhood experts. The key is to start with a change idea that fits your health center’s current priorities, capacity, and community needs.
When selecting a change idea:
- Start with an area where improvement is needed or requested by staff or families.
- Choose a change that is small enough to test quickly (e.g., one provider, one age group, one clinic).
- Involve a cross-functional team to design and evaluate the test.
- Include family voices whenever possible as partners in improvement.
- Use short learning cycles to gather feedback and refine the approach.
Community health centers can use the Quality Improvement Readiness Checklist and Prioritization Table for ECD Change Ideas to help determine where to begin.
Quality Improvement Readiness Checklist and Prioritization Table for ECD Change Ideas
This checklist helps community health centers assess current practices and identify opportunities to strengthen ECD services.
