For children to develop to their full potential, ‘nurturing care’ during the early years is required. Multi-sectorial, integrated interventions enable nurturing environments by adopting an individual-child and family perspective. Mihaela Ionescu, Program Director at ISSA, sums it up like this: “No one can whistle a symphony. It really requires an orchestra.” The conversation that follows reflects this view, and what it implies for Early Childhood Development (ECD) services.
What do you mean by “integrating child services”?
Integrating child services is about articulating the why and how of the services we offer. Health, education, a safe and stimulating environment at home and in public spaces… none of these is more important than the other, but there’s a lot of misalignment and overlapping among them and things that are missing. That is why we have to address them in an integrated way. If at home a child does not have enough food, safety, income, attention, stimulation, the daycare service will never be sufficient. This approach takes into consideration the condition of each specific child, so each service, while addressing their specific need, knows what happens to the child when they are approached by another service.
Why are integrated services important for early childhood development?
Because we have to address all the aspects of child development together, in an aligned and coordinated way. Child nutrition, safety, early learning, and all other aspects contribute fundamentally to the child’s overall well-being and development. A holistic perspective is critical for these conceptual reasons, but also because there is an imperious need to address the increasing diversity, poverty, and conflict around the world, which are dramatically affecting children’s growth and development, especially in the early years. Early years, particularly pre-natal to three years old, are so crucial.
What are the challenges to implement integrated early childhood services? What are the opportunities?
Early childhood workers are critical to supporting integration of services, they have to embrace a culture of dialogue and cooperation, of working together across services. It is a mindset change. For this to happen, leadership is paramount. A managerial culture that allows cooperation and participatory growth in and beyond the workplace is necessary, otherwise cooperation is very hard. Leadership is essential also for integrating services at community or local levels. Cross-partnerships, discussion and dialogue are the hardest part, because shared-decision making is often not considered, and that’s why it’s not happening.
The leader must create opportunities for people who work in different types of services to meet and have professional development activities together, establishing a common language and understanding of early childhood development, supporting families in their roles, implementing quality and inclusive practices… For example, a home visitor should meet with the health worker and the educator to understand the child’s needs from the work they are each doing and how all of them together, with an aligned and consistent approach, may be positively affecting the child’s development. This is the place where innovation can come: in identifying spaces for ownership in the community, involving and supporting the families and learning from them what they need and deserve.
You’ve mentioned top-down and bottom-up approaches for integration to take place. What’s the difference, and is there a preferred course of action?
In top-down (t-d) approaches, there’s a policy and governance in place meant to create shared understanding, but it will not replace the know-how. It might establish a common language, but it might not cover all the levels needed to actually ensure integration happens. And if you do not listen to what the people in the system want to do or are capable or trained to do, you will not create the conditions for this to happen.
Bottom-up (b-up) approaches can be more successful because they’re very grounded in real contexts, in listening to professionals, families, communities and involving them, paying attention to child and family needs and tailoring plans according to their voices and experiences. It’s a longer journey… building a common vision, values, shared language, understanding, responsibility and common planning and decision-making takes time.
Whether t-d or b-up approaches, the main point of reference is the individual child and the family. The approach must respond to their real needs.
Who’s responsible for integration? What are the necessary conditions to ensure it happens successfully?
Different actors, since services are provided within a system at different levels and each level has their own role. Ideally, integration should happen at three levels – individual, service and inter-institutional – with specific responsibilities assigned at each level to holistically address the child and family, with consistent and shared goals, planning, responsibilities, joint services, communication, and policy.
At the individual level, all professionals are responsible. The institutional/service level depends on both individual and leadership management, and in the inter-institutional, responsibilities are shared amongst institutions at local and community levels. Therefore, all levels are responsible.
Any thought-provoking ideas you would like to leave us with?
Something I’ve learned is that no one can whistle a symphony. It really requires an orchestra. And that is what integration is about. As professionals, parents, and communities, we must look at everything the child deserves and needs, and step outside the narrow and siloed way of looking at them. With all the love we have for children, we’ll want to work together, build bridges instead of islands. The main question is, “How can we better respond to what a child has the right to have?” And to answer it, we need critical-thinking professionals and visionary leaders in the workforce, open-minded people who listen and respond to actual needs and work towards efficient, participatory and collective services in communities. It’s a long process, but it’s worth it. As long as we keep our minds focused on the child, that’s the most important thing.
What integration practices in the early childhood workforce exist in your country? What are the main challenges or opportunities for integration in early childhood services? Tell us in the comments section or mention @BIDgente on Twitter.
Mihaela Ionescu is Program Director at the International Step by Step Association (ISSA).
Mihaela, thank you for your words of wisdom and experience fostering integrated services! I love your analogy of an integrated service to needing an orchestra to play a symphony! Children can not grow and thrive to their full potential without that orchestra and playing in sync. The cost of maintaining silos and duplication of efforts is too great for the well-being of children and nations. I also appreciate your recommendation to take a bottom up approach and using an ecological model to find ways to ensure that children’s health, nutrition, and learning needs are met, especially in the 0-3 age group when the foundation for future development is established. Families and communities that are supported with resources and knowledge and empowered to make the decisions are more likely to make this a reality. We all play an important role in the orchestra! Thanks!