Too many young children and families lack access to proper healthcare and early education. To address this need, the New York State Department of Health put forward the First 1,000 Days of Medicaid initiative, which aims to improve lifelong education and health outcomes for underserved children by focusing on early childhood development program and interventions. In a new episode of Policy Outsider, guest Melodie Baker, project leader of the Rockefeller Institute’s partnership project with the Department of Health on the First 1,000 Days initiative, joins host Alex Morse to discuss how using local collective impact strategies might help strengthen these innovative practices designed to increase education attainment and health access for children and families in need.


Melodie Baker, Project Leader, First 1,000 Days Partnership Project

  • Transcript

    Transcript was generated using AI software and may contain errors. 

    Alexander Morse 0:04

    Welcome to Policy Outsider. I’m Alex Morse. Today, too many children and families are in need of access to proper health care and education. To address this need, the New York State Department of Health has put forward the first 1000 Days on Medicaid Initiative, which aims to improve lifelong education and health outcomes for children in need by focusing on early childhood development through a series of programs and interventions. Today’s episode, we’ll invite Melodie Baker, project leader of the Rockefeller Institute’s Partnership Project with the Department of Health on the First 1000 Days Initiative. Melodie will highlight some of the promising practices of the First 1000 Days Initiative and discuss some of the strategies identified by the Department of Health that helped increase education attainment and health access for children and families in need. Coming up next.

    Alexander Morse 1:26

    Good morning, Melodie. Thank you for joining us at the Rockefeller Institute today. How are you?

    Melodie Baker 1:31

    I am well. Thank you so much for having me.

    Alexander Morse 1:34

    So let’s just jump right into it. Can you talk about what this program is, the First 1000 Days on Medicaid? And what is the Rockefeller Institute’s Partnership Project all about?

    Melodie Baker 1:45

    Absolutely. So the First 1000 Days Initiative recognizes that a child’s brain goes through a critical period of development from birth to age three. And this initiative is about better coordinating services to enhance programs and policies to ensure that children and infants develop healthy during this very critical period. So the idea of the partnership was to bring the Rockefeller Institute of Government and a strategic approach that involved collective impact to essentially leverage existing resources to build the capacity of the New York State Department of Health.

    Alexander Morse 2:26

    Why is it so important to focus on this population of zero to three?

    Melodie Baker 2:30

    Zero to three is a critical time period. It’s when the brain is developing and the majority of a child’s brain between the age of zero to three has the most development in that individual’s entire life, and investing early to ensure that the child has all of the resources that they need for the most effective brain development possible. It makes sense and that’s what the research says. So focusing during that time, we found that it has the highest yield of return on investment. The problem is that children in New York State, they’re at risk of not achieving their full potential due to individual- and community-based disparities. And what the goal of this project is to look at community resources and see how we can strengthen them so that they can better support children and families who are being served by Medicaid.

    Alexander Morse 3:34

    Now what are some of these different initiatives or strategies that are being implemented? You mentioned investing in this zero-to-three population yields some of the greatest returns. What does that look like?

    Melodie Baker 3:46

    So initially, 200 stakeholders came together and they identified 10 different strategies. But five of the 10 strategies would be implemented in pilot communities. And the five has actually been set up now as a bundle and the first one is an early literacy strategy. We know that it is really important for children to learn to develop early literacy skills, to build phonological awareness, to essentially be able to identify letters and words and how to hold a book. And they are realizing that strategy through a national approach called Reach Out and Read. It’s really an exciting one. It’s one that I’ve been familiar with for quite some time. It is an approach where a pediatrician will essentially provide books and a prescription based on what the child’s needs are during a general pediatric appointment. And it’s great because it tends to increase the likelihood that parents and children and families will attend these visits and it’s a great relationship building tool. It’s a great way to develop literacy skills. And the coolest thing about the early literacy project, the way it is designed, is they’re taking books, not just any books, but books that truly address the needs of children and families. And culturally. So if the child’s first language is in Spanish, the book is going to be in Spanish. And if the child is, let’s say, fighting with their siblings, the pediatrician will prescribe a book that talks about how to get along better with your brothers and sisters. So they really take an approach that makes the most sense to that child and that family. So that’s the cool thing about the Reach Out and Read Initiative. The other initiative that they have is the MICI pilots. So the MICI pilot stands for Maternal Infant Care Initiative. That is an approach that includes peer family navigation, it includes a light touch home visit, and it’s really more focused on providing the support that children and families need. So if a child during one of those light touch home visits, something comes up by the way of health resources, a peer navigator provides resources and support to that family to ensure that their needs are met, which is an incredible resource, especially for families who do not know how to navigate the system. That’s one of the biggest areas of concern, we have a lot of resources in New York State but not a lot of families know how to get to those resources. So the MICI pilot definitely addresses that. The MICI pilot also includes a data integration piece, which ensures that all of the providers really understand what these childrens’ needs are. And all of these initiatives are evidence-based models, proven models that truly ensure that these outcomes that we’re looking for in New York State to achieve that they are achieved.

    Alexander Morse 7:12

    What I like about these initiatives is that it’s making it easier for parents. For Reach Out and Read, they’re handing out the books at the doctor’s appointments, which means parents don’t have to attend an after-school event that they might not have been able to attend, or in the MICI program, it’s home visits. We’re reaching the families and trying to provide for them and those initiatives.

    Melodie Baker 7:37

    Absolutely. And the really cool thing about it is that many of these pediatricians and many of these providers because they’re so familiar with working with this population, they take an innovative approach to making sure that their needs are met. Unfortunately, some of the things that I’ve heard from these pilots is that many of these families because of housing concerns, they might live in Brooklyn one month and another month they live in Manhattan or they’re living in the Bronx. And what they’ve been able to do is make connections with other housing shelters to make sure that whatever the needs are that they discovered that the next place, whether they’re being served in Brooklyn or in the Bronx, that those needs are being met, which is really exciting. Another thing that they do, recognizing that the populations might not have the resources to go to a library or again, if they do live in in Brooklyn, they might not have a library card for the Bronx, they’ll set up these reading nooks or these literacy areas, literacy libraries, in shelters. In areas that are actually accessible to them. I thought that was truly an innovative approach to reaching that community state-level goal of early literacy, which truly prepares children to be ready for kindergarten, which is exciting.

    Alexander Morse 9:04

    Now, is this First 1000 Days on Medicaid, is this limited to underserved populations or low-income families? Or is this open to anyone that is in the universe of zero-to-three population?

    Melodie Baker 9:19

    So that’s a great question. So the First 1000 Days is limited to underserved families and families who are being supported by Medicaid, which is important because those are the children who need the support the most. And just from a point of view from a statistician, if you can help the most underserved population, you can then move the needle for the entire population. So children zero to three in order to participate in this program, you do have to meet the federal poverty guidelines to be supported by Medicaid. But additionally, one other thing that is important is that the Reach Out and Read Initiative and some of these other initiatives, they are not limited to children and families on Medicaid. Those are more national initiatives, so they don’t have the same requirements. However, for this pilot, the Reach Out and Read Initiative because of the evidence-based approach, it was selected to support Medicaid children and families.

    Alexander Morse 10:26

    And sticking with this evidence-based approaches and tracking outcomes, I suspect that these children that are being served, the zero-to-three population, you’re going to be tracking them throughout their schooling, throughout elementary school, high school, higher ed?

    Melodie Baker 10:45

    I would love to do that but actually no. What my work in this particular project is actually to track the community resources and the work that is focused on collective impact. So what I am trying to see, I use benchmarks and indicators that the First 1000 Days Initiative team identified, such as how many families are being served, how many books are being distributed. I use that information to understand whether or not the system, the community partners, the community business organizations are essentially effectively providing the support to the providers. So my work, as far as evaluation is concerned, it’s really focused on the collective impact side of that. Are we coordinated in the sense that we are being supportive to the providers? Because I don’t know if you’ve ever partnered with an organization or anything, sometimes it can be more work partnering with an outside entity and they can take your attention away. So what my work really is centered on is more like a seamless approach. So that provider doesn’t have to spend all their time working out the kinks and making sure that that project is being implemented successfully. One example I love to use is everybody remembers Hurricane Katrina, when that happened, the entire world, the whole country, started sending a ton of resources to New Orleans—teddy bears, clothes, all these things. It was great what they were doing. However, the problem was there was not really a coordinated system to collect all of these items. And it took more time away from the people who were supporting the people who truly needed the help to get all these items, like people didn’t need teddy bears. The clothes were great, but they needed clothes in certain sizes. Some of the clothes were used and soiled. So what ended up happening, out the goodness of all these people hearts, they had the best intentions but it really took the people away. It really took time and effort away from what really needed to occur, to deal with this massive amount of things and stuff that were not usable. So my job, essentially, is to make sure that teddy bears and things that are not needed are not being sent to these particular communities and to make sure that their needs are truly being met and being identified by linking the right resources in a seamless fashion.

    Alexander Morse 13:43

    And so you talk about collective impact and trying to leverage existing resources to work together, to work collaboratively. How do you achieve sustainability? How do you make sure that these programs are going to last and be effective in the long term?

    Melodie Baker 14:00

    Oh, that’s a great question. Building sustainability is a big part of this model. And the great thing is it’s built directly into this partnership. The idea is these resources may not last forever, we’re very grateful for them, but New York State is one of the most highly funded states, where we have the most social services out of other states in the country. So really looking at the existing resources and leveraging those and building this comprehensive system of support is how we build in sustainability essentially. So there are resources. And the challenges is coordination as we know and making sure that this particular resource is going where it needs to go. So it’s really about what are your existing resources that are already funded? They might not be funded through Medicaid. They might be funded through Health and Human Services or some other initiative. But really how do we make sure that they are effectively addressing the right population? We’re mitigating duplication through coordination but essentially what are these existing resources that can be leveraged? Now the way that we make sure that they stay intact and they’re around for the long run is through advocacy and policy reform. We say, okay, we have this model, we know that collective strategies tend to work the best because you have diversified resources coming from multiple areas. We’re not constantly depending on state resources but we’re depending on other resources that might be funded through a foundation. But essentially advocating for those and making sure that there’s policy reform so that people and government and organizations realize that the work that is being done is effective. Those funding streams continue to be funded to make sure that this model is sustained. Ultimately, we’d like to see statewide Medicaid reform to see that these pilots are funded through the long run, but if not, this collective impact model is how we’re looking to sustain the work that’s being done.

    Alexander Morse 16:32

    So I want to take a quick step back and just talk about the First 1000 Days on Medicaid in terms of what’s actually going on in New York State. How are these programs being tested out?

    Melodie Baker 16:45

    So what the New York State Department of Health did, they identified pocket communities and that is where they implemented them throughout the state. So some of them are in a particular county, some of them are in cities, but essentially what they did is they identified communities where the pilot should be implemented. And that’s what they did. So it’s not technically statewide. There are small pilots throughout the state where these pilots are being implemented.

    Alexander Morse 17:18

    So these projects are going on a small scale in pockets throughout the state. And you’re hopeful that state reform and advocacy can help fund these projects in the long term. What are your next steps?

    Melodie Baker 17:32

    So next steps are to see these pilots expanded. And we’re actually already seeing that, which is really exciting. The New York State Department of Health has committed funds next year to either expand the existing pilots or to increase the resources for the existing pilot. There will either be more pilots or more resources given to the existing pilots, which is exciting. That’s exactly what we want to see because, ultimately, we want to see all communities having this comprehensive approach to early childhood development.

    Alexander Morse 18:13

    Big thank you to Melodie Baker, the Rockefeller Institute’s project leader for the Department of Health’s First 1000 Days on Medicaid. We’re excited to learn more about these programs and see which of these initiatives yield real health and education benefits for young children and families in need across New York State and possibly beyond. If you liked this episode, please rate, subscribe, and share. It will help others find the podcast and help us deliver the latest in public policy research. All of our episodes are available for free wherever you stream your podcasts. Special thanks to the Rockefeller Institute staff Joel Tirado, Heather Trela, Laura Schultz, and Brian Backstrom for their contributions to this episode. Thanks for listening. I’m Alex Morse. Until next time.

    Alexander Morse 20:22

    Policy Outsider is presented by the Rockefeller Institute of Government, the public policy research arm of the State University of New York. The Institute conducts cutting edge nonpartisan public policy research and analysis to inform lasting solutions to the challenges facing New York State and the nation. Learn more at or by following RockefellerInst on social media. Have a question, comment, or idea? Email us at mailto:[email protected].

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