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2004 Model Practice Application (Public)
Application Name: 2004 Model Practice Application (Public) : Cambridge Public Health Department : Let's Talk…It Makes a Difference!
Applicant Name: Mr. Claude-Alix Jacob, DrPH, MPH
Let's Talk…It Makes a Difference!
Cambridge Public Health Department
The goal of the Let’s Talk Campaign is to improve the quantity and quality of conversations taking place between young children and their parents. Increased communication has two benefits. First, it helps children develop large vocabularies and good background knowledge – strong predictors of academic success. In addition, literacy is strong predictor of health outcomes. Second, parents who communicate care and acceptance to their children are providing supportive parenting. Children who experience supportive parenting report fewer physical and psychological symptoms during childhood, adolescence, adulthood, and even old age.
The objectives of the campaign are (1) to educate parents about the importance of talking with their children and (2) to model techniques parents can use to have rich and elaborate conversations with their children. Tasks include developing an action plan; creating and launching a campaign; and planning, organizing, and facilitating events. Families living in public housing are the target audience. Children living in Cambridge public housing have shown a decade-long pattern of underachievement in the city’s public school system. The Let’s Talk Campaign targets 16 percent of families with children (age 5 or younger) who live in public housing. The short-term outcome of the campaign is that parents gain the knowledge and motivation to improve the content of conversations with their children. The intermediate outcomes are that parents learn techniques that generate more complex conversations, even on difficult topics, such as children’s rights versus parents’ rights. Long-term outcomes concern both literacy development and health. The literacy outcome is that children will have a larger vocabulary and more background knowledge. The health outcome is that supportive parenting will help children develop the psychosocial resources associated with good health outcomes throughout life.
Responsiveness and Innovation
The literacy initiative focuses on talk as a way to teach early literacy skills to very young children. Contrary to traditional early childhood literacy programs that often overlook a parent’s role as educator, this new campaign emphasizes the message that parents are a child’s first and most important teacher of language, even after formal schooling begins. Because the campaign does not focus on reading, it can empower parents who were not successful in school, cannot read and write, or have a limited capacity to speak English. By promoting talk between parent and child, the campaign accomplishes two important things:
- First, it helps parents express their acceptance of and care and support for their child. When children receive positive parenting messages, they are more apt to develop the psychosocial resources of personal control, self-esteem, and social connectedness that are linked to good health outcomes.
- Second, by promoting talk between parents and children, the campaign is building early literacy skills that serve as the foundation for learning to read and write. Through conversations with adults, children learn vocabulary as well as acquire knowledge about the world in which they live.
The Let’s Talk campaign is forward-looking in its approach to early literacy and to strengthening parent-child relationships. The campaign also builds early literacy skills that help children learn how to read and write. It also empowers parents who may not be proficient in English to remain involved in their children’s literacy development. This in turn develops parenting skills that lead to better health outcomes for children.
Within the field of early childhood literacy development, Let’s Talk is considered innovative. Most literacy programs stress reading to children. Let’s Talk, however, focuses on developing vocabulary and background knowledge. What is so important about talk? After all, don’t all parents talk to their children all the time? While the answer is certainly yes, it is important to note that today’s harried parents often speak to their children (or at them), not with them. This type of talking does not build strong parent-child relationships, the hallmark of good parenting, nor does it build early literacy skills.
Agency Community Roles
The Cambridge Public Health Department (CPHD) is the lead organization for the literacy initiative. As such, CPHD funds the Let’s Talk campaign, provides it office space for the literacy staff, supervises the literacy staff, hosts and maintains the campaign’s Web site, and advocates for the campaign at local and state levels.
An added bonus of having CPHD as lead organization is that it has been able to apply a public health lens to literacy issues. As programmatic logic models were developed, public health staff suggested that the literacy coordinator consider different behavior change models, such as Health Belief model. This infusion of theory has enriched the literacy staff’s thinking about how parents go from inaction to action.
The Cambridge Public Health Department is one of the five city departments that collaborate on the Agenda for Children. The other four city agencies are the Department of Human Service Programs, the Cambridge Public Libraries, Cambridge Public Schools, and the Cambridge Police Department. Other partners include Concilio Hispano and the Cambridge Community Foundation. Each partner plays a specific role in Agenda activities and contributes financial support. In addition to their work in identifying and prioritizing Agenda for Children goals, each AFC partner assigns staff to advise and support the Let’s Talk campaign. Operational staff serves on an advisory board. In this capacity, they review the campaign’s effectiveness and offer suggestions. Directors serve on a steering committee, which is co-chaired by Harold Cox, the Chief Public Health Officer for the City of Cambridge.
Because CPHD has strong links with local churches, citizens’ groups, city agencies, and community-based organizations, the department has been able to connect campaign staff to new stakeholders. For example, CPHD introduced several black pastors to the literacy staff. Following this, literacy staff trained church tutors who later organized a literacy event in a nearby school. CPHD must also ensure that the community consistently supports the campaign. To do this, it looks for ways to publicize the campaign’s effectiveness. It also works to secure continued and expanded funding from a variety of sources. Lastly, it protects the literacy staff from outside pressures that could divert them from their mission.
Costs and Expenditures
Costs for this initiative include a literacy coordinator ($27,500), materials assistant/administrative support ($3,000), part-time literacy staff ($3,000), outreach worker ($550), giveaways and print material ($8,000), food at events ($750), event supplies ($900) and evaluation ($10,000). Total costs for the initiative are $53,700. In-kind contributions supplied by CDPH include office space at CDPH ($12,000), supervision for literacy coordinator ($10,000), and Web site development and hosting ($1,200). Other in-kind contributions include rental of public housing community centers ($500). Total value of in-kind contributions is $23,700. Funding for the campaign comes from a variety of sources. Since the literacy coordinator is a City of Cambridge employee, the Department of Human Services Program pays her salary. The Cambridge Housing Authority, which controls all public and Section 8 housing, provides free use of their facilities as well as mailing addresses of residents with children age 5 or younger.
The Let’s Talk campaign has two objectives: (1) to educate parents about the importance of talking with their children and (2) to model techniques parents can use to have rich and elaborate conversations with their children. To meet the objectives, the campaign activities include:
- Developing an action plan.
- Hiring a literacy coordinator.
- Choosing, designing and launching a campaign.
- Holding parent-child activities.
- Giving presentations.
- Hiring an evaluation consultant, developing evaluation tools, and conducting an evaluation.
Partner commitment to and participation in the campaign is high. Of the five partners, two fund the Let’s Talk campaign. Commitment to sustain the Let’s Talk campaign is strong. All five partners or stakeholders have pledged to fund the campaign for many years to come. In addition, Mayor Michael A. Sullivan and the Cambridge Community Foundation have organized fundraising events to raise money for the campaign. The AFC and its independent program evaluator, the Institute for Community Health, have also submitted concept papers to four national funders to expand the number of public housing residents served by the Let’s Talk campaign, as well to implement participatory research.
Outcome Process Evaluation
Evaluation tools include participant demographic data, focus groups, and satisfaction questionnaires. Participant demographic data surveys gathers information on who attends events. Focus groups allow staff to learn what participants’ think about outreach strategies, the effectiveness of the Let’s Talk message, and the cultural relevance of suggested talk techniques. Satisfaction questionnaires, administered orally at the end of events, gage whether or not core program values are being met. Feedback obtained from these tools help improve the practice.
Data collected shows that 61% of the parents who live in public housing and have children age 5 or younger were reached by the Let’s Talk campaign.
Focus groups have provided staff with a wealth of information to improve the campaign. Some input will modify outreach methods (e.g., time of events, how events are promoted). Parents also expressed a desire for workshops on a variety of topics: sibling rivalry, curbing TV and video game time, and developing phonemic awareness. This shows that parents are truly seeking resources to help them parent.
Satisfaction questionnaires have shown that the program is meeting the core values. Parents feel valued. They report that activities are child-friendly and fun. They have also demonstrated that they trust literacy staff enough for parents to feel comfortable asking for advice or referrals.
There have been many challenges in implementing the program. The target population is difficult to reach. Many people who first started coming to events have moved to cities with lower housing costs. Also, public housing residents work long hours. They often work two low-paying jobs to make ends meet. Taking public transportation often adds to these long hours. As a result, time is almost their most precious commodity. To adapt to the ever changing resident population and their lack of availability, activities will be offered several times in different developments (i.e. morning and afternoon).
The campaign’s logic model outlines the following program theory: (1) Parents need to have knowledge; (2) Once they have the knowledge, they are motivated to act; (3) Motivation to act causes parents to act intentionally; and (4) When intentional, parents employ certain techniques to improve the quantity and quality of their conversations with the children.
Through evaluation, program staff have confirmed the first two premises of the program theory. Parents do want to be educated and are motivated to help their child succeed academically. Attention must now focus on how to get parents to intentionally employ techniques that enrich conversations with their children. Based on focus group feedback, the first step will be to be more explicit about “what” techniques to use “when” should be the first step. Parents are motivated to be good parents. They seek education on how to parent. Therefore, the campaign broadened its literacy development talk message to include parenting talk – how parents can talk to their children about issues or problems.
What makes the Let’s Talk campaign work is that there is a citywide commitment to a literacy goal. This motivates city departments to work on the campaign. The collaborative infrastructure of the Agenda for Children also makes it easier to get things done. While other health departments may not have either a citywide goal or an existing infrastructure, they could use school success or parenting to rally support for such a program.