Acknowledging the uncertainty and anxiety of the present times, Commission Chair Sheila Kuehl welcomed Commissioners to the March 12 board meeting with words on the COVID-19 pandemic:

“In a time of high anxiety, it’s even more important for us to recognize the role that we have in being steady, being intentional, being collaborative, being kind and mindful … In the face of all this anxiety, not being able to necessarily cure it … but to be there for each other, do our work and focus on that. Each of that in our own areas and First 5 LA as a whole.”

In the week leading up to the board meeting, First 5 LA leaders, staff and Board — many of whom hold positions within city, county and state systems — have been taking steps to prepare for potential shifts in administrative and business operations to slow the spread of COVID-19.

Executive Director Kim Belshé added to Kuehl’s remarks, urging others to respond to the pandemic with “preparedness not panic, facts not fear.” (Click here to view the latest update from Belshé on COVID-19.)

“It is times such as these that we see so directly, immediately and concretely all that is good and true about public service, and people doing mission-driven work,” Belshé said.

On the topic of people who have dedicated their lives to mission-driven work, Belshé and the Board gave a warm farewell to First 5 LA Family Supports Director Barbara DuBransky, whose last day of employment coincided with the meeting.

“It’s important to know as we look back over almost 20 years that there has been a continuous string of change and accomplishment and caring because of you, and this Board is very, very grateful to you,” Kuehl said.

DuBransky has worked for First 5 LA since 2000 and is moving on to become the Chief Deputy Director of First 5 Riverside County.

The remainder of the board meeting was dedicated to informative presentations on systems change though First 5 LA’s partnerships, specifically in home visiting and early care and education (ECE).

Health-Related Systems Director Tara Ficek, Family Supports Senior Program Officer Anna Potere, and DuBransky (in place of project consultant Jill Rivera Greene who could not attend due to the COVID-19 travel guidelines) presented “Impacting Change System Though Health Partnerships: Spotlight on Home Visiting.”

Since January 2019, First 5 LA has been in a partnership with Promise Blue Shield, one of Medi-Cal’s managed care plans (MCPs), piloting an “auto-referral” home visiting program in the Antelope Valley in which women get referred to a home visiting program as soon as they test positive for pregnancy.

“Home visiting helps these [managed care] plans meet their goals and what they’re accountable for,” Potere said, explaining how Medi-Cal MCPs that engage in home visiting are more likely to avoid costly adverse birth outcomes such as preterm or c-section births, which in turn help them meet their financial goals.

Additionally, Potere reported that quality improvement requirements, such as maternal mental health screening mandated through AB 2193, were met more easily through home visiting, and at a rate of 100%.

On behalf of Rivera Greene, DuBransky shared observations that Rivera Greene had after shadowing a home visitor as part of her recently published report Connecting the Stars: Chronicling the Expansion of Home Visiting Programs.

According to the account, Rivera Greene saw how a home visitor was able to build connection and confidence with a new mother who had recently immigrated from Bangladesh. When asked how she was able to build this trust, the home visitor explained that she accepted food, was open to their culture and reassured the mother that she was the expert on her own child. In turn, the mother reported feeling more confident taking care of her infant, adding enthusiastically that she had already referred her sister, who was in the process of trying to conceive, to the program.

“We can talk about the data and all the other fancy stuff, but it boils down to two people communicating and being respectful of each other,” Commission Chair Judy Abdo commented.

“This told me so much about how culturally relevant this service was, how the provider had empathy for the community they’re serving and how they built the relationship,” Commissioner Romalis Taylor added. “That’s why data, as well as the story, is important.”

For more information on First 5 LA’s partnerships with Medi-Cal Managed Care Plans, click here.

Lastly, First 5 LA Early Care and Education Director Becca Patton, Los Angeles County Office of Education (LACOE) Projector Coordinator Lindsey Hanlon and LACOE Program Manager Liz Guerra presented, “Systems Change through ECE Partnerships.”

Since 2015, First 5 LA has been a funder of Quality Rating and Improvement Systems (QRIS) — the systematic way to assess, improve and communicate the quality of ECE centers to parents and stakeholders. Licensed centers and family child care homes volunteer to be evaluated on a 5-point scale and participate in quality improvement activities.

Patton explained how First 5 LA, in keeping with the strategies outlined in the 2015-2020 Strategic Plan and alongside partnerships within the L.A. County QRIS Architects group, aligned what was once three QRIS funding streams with different measurements and standards of quality into one countywide assessment system known as Quality Start Los Angeles (QSLA).

“Because we’ve achieved these goals, QSLA has been able to become a trusted thought partner with both the California Department of Education and First 5 California. In the past three years, storytelling around our successes and challenges have informed key decisions both with the California Department of Education and First 5 California with the roll out and structure of current funding.”

Patton explained how this positioning has put First 5 LA in an auspicious place for meeting QRIS goals laid out in the new 2020-2028 Strategic Plan, specifically within the context of equity, systems change, partnership and sustainability.

With this new strategic focus, Patton told the Board that First 5 LA has already had some early wins: In partnership with LACOE, First 5 LA is currently in the process of aligning more funding streams under QSLA to broaden impact and ensure equitable inclusion of more diverse provider-types, including family-based centers where many of L.A. County’s 0-3 population receive care.

Guerra gave an example of this win, citing the recent alignment of funding by Quality Counts California (QCC) — the statewide locally implemented QRIS system which is overseen by First 5 California and the California Department of Education’s Early Learning and Care Division.

As co-chairs of the QSLA Leadership Council, First 5 LA and LACOE have been meeting quarterly with QCC representatives to inform them of successes and challenges and serve as a thought partner as they make strategic decisions that impact implementation of the quality improvement system. Input from the QSLA Leadership Council has helped shape QCC’s decision to align funding streams and expand reach to a larger diversity of providers, including family care centers.

As tight partners, First 5 LA and LACOE both recognize the importance of coordinating funding sources, programming, and systems priorities, and collectively working together to expand the concept of quality improvement systems — with less emphasis on the “rating” aspect of QRIS — for more inclusive and equitable outcomes that will support providers beyond center-based care.

“We know many of our youngest learners are in family child care homes and we are currently revisiting our current structure to offer [these homes] the best support and incentives to participate in our quality rating and improvement systems,” Guerra said.

Patton concluded her presentation by noting the challenges on the horizon, including the fact that the planning, funding and implementation of this quality improvement model all happen within a short time frame and within the constraints of funding requirements.

“It’s clear to me that the work has been extraordinary, bringing together so many disparate areas and coming together with one thread,” Kuehl commented.

Due to the state and county’s current health guidelines around COVID-19, logistics around the April Commission meeting are still to be determined.

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