Connecting Research with Practice

Emily E. Davis is a junior concentrating in Cognitive Science. In this post, she reflects on some of the obvious and not-so-obvious challenges of connecting research with practice.

When I joined the “Baby Brains” group, one of the three smaller work groups that make up the Healthy Early Childhood Development TRI-Lab, I was surely not expecting that the majority of our work would revolve around event planning.

However, this semester has provided me with valuable insight into how to connect academics and community practitioners in the field of early childhood development. Working with my team to develop a symposium on the issue of executive function skills in children has allowed me to see some of the barriers that exist.

These barriers start with the basic logistics of the event. One of the questions that has inspired the most debate within our group, and one that we still do not have an answer for, is where the event should be held. If we hold the symposium on Brown’s campus, we worry that community members will not attend because of the lack of parking; but, if the event is held elsewhere in Providence, students might not be willing to make the trek off of College Hill.

See our problem?

In a meeting that we had with representatives from the Rhode Island Department of Education, to gain advice on topics for our symposium, what I heard stressed again and again was to make the issue of executive functions relevant for education professionals. Specifically, my notes say “concrete examples of how executive functions manifest in the classroom.”

Do you know what executive functions are? I think of how my mom, an elementary school teacher, and I can’t imagine she does. If you’ve read this far without knowing what I’m talking about, let me explain. “Executive Functions” is a term for a collection of skills including working memory, inhibitory control, and cognitive flexibility. Executive Functions allow us to control our behavior and make decisions in complicated situations.

The challenge is to educate people like my mom on this topic while also making the symposium worthwhile for researchers who are already very knowledgeable about executive functions. We want to show working professionals the importance of executive function skills without oversimplifying the issue by propagating myths: “Do _______ every day with your students and their executive functioning will soar through the roof!”

The most obvious answer would be to have separate workshops where those working professionals who know little to nothing about executive functions can learn more, those who have some knowledge can learn about possible intervention opportunities, and those who research the issue on a daily basis can… talk amongst themselves?

No, that’s not going to work. In order to truly connect research and practice, we need to create spaces for academics and education leaders in Providence to form meaningful partnerships that will lead to future collaboration.

The ideal outcome would be interventions designed to improve executive function skills in children that would also allow the academics to collect valuable data from these children to further their research.

We still have a lot of work ahead of us in designing this symposium, but I am excited by the challenges and think we can pull it off. We look forward to seeing you at the symposium on October 2nd, 2014 (location TBA!).

Integrative Scholarship

Alexandra D. Urban ‘15, who is concentrating in Educational Neuroscience, has spent much of her Brown experience focused on integrative scholarship.  She reflects on how TRI-Lab fits into her larger course of study as well as how it exemplifies the goals of interdisciplinary study and applying academic research beyond the classroom.

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Michael Salerno Photography

At the Dean of the College and Campus Life staff retreat last week, I had the pleasure of hearing about the university’s new focus on integrative scholarship.  This concept, taken directly from Brown’s recently approved Strategic Plan, highlights the importance of fostering interdisciplinary study and thinking critically about how to apply academic research.

Deans, faculty and staff gathered together to learn more about integrative scholarship, how it’s currently being implemented at the university, and future plans to expand such programs.  At this event, I had the exciting opportunity to share my experiences of TRI-Lab, Brown’s flagship initiative for integrative scholarship.  In fact, I had the chance to explain my broader course of study at Brown and how TRI-Lab has fit into my larger framework of integrative scholarship.

Freshman year, I volunteered at Asa Messer, an elementary school in Providence, to help run an afterschool mathematics program for second and third grade students.  In addition to several other experiences teaching and tutoring, my time at Asa Messer kept me asking: What teaching methods work best?  How can we identify which techniques lead to optimal student learning?  I desperately wanted to study these questions in my college courses and began dedicating any project or paper I could tailor to this science of learning.

By the middle of my sophomore year, I discovered that the Neuroscience, Education, Mathematics and Cognitive Science courses that I was so drawn to could be combined to create a single course of study: thus, I designed an Independent Concentration in Educational Neuroscience, in order to understand how we learn on a biological level and to apply this knowledge to improve teaching.  Creating my own concentration was a direct result of wanting to apply academic research to a broader context, to take what we know about the human brain and change what happens in public school classrooms.  In essence, this is exactly what we do at TRI-Lab every day: take academic research and twist it inside out in order to find new applications for improvement in our community.

My independent concentration then led me to the Brown International Scholars Program (BISP), which funded a research project of my own design.  Just like TRI-lab, I was able to tackle challenging problems with academic rigor previously gained: I travelled to New Zealand to investigate how Neuroscience evidence relates to their teaching methods in their high-achieving, public school system.

Finally, in my junior year, I have had the incredible opportunity to become a part of Brown’s inaugural TRI-Lab.  Each week we get together to share knowledge, brainstorm ideas and challenge each other’s preconceptions about how the Rhode Island landscape of child services could and should be changed.  We bring together anthropologists and advocates, doctors and designers, educators and economists – the strength and breath of our interdisciplinary team is extraordinary.

Taken together, TRI-Lab represents a quintessential example of integrative scholarship.  Not only has it played an important role connecting academic coursework and community impact in my microcosm of a Brown experience, but it also acts as a crucial step in the university’s path towards greater communication between disciplines and stronger emphasis on applying research to benefit our surrounding Rhode Island residents and beyond.  I am immensely grateful for my involvement in TRI-Lab and hope that many more students will have the opportunity to test the waters of integrative scholarship as I have.

The Holes You Can’t See

Natalie Posever ‘14.5 is an anthropology concentrator. She has volunteered as an advocate for Health Leads at Hasbro Children’s Hospital since the fall of her freshman year, and is continually reminded of the power of a child’s environment to dictate his health and well-being with each day she spends at the clinic.

I recently read a book that detailed the process low-income women have to go through to obtain free public prenatal care in New York state. The application process takes an entire day, a day during which the mother-to-be must take time off of work, leave the older kids with a friend, and travel to the prenatal clinic. At the clinic, she will take a pregnancy test (no, it doesn’t matter if you’ve taken one already,) meet with a nutritionist, social worker, nurse, and financial counselor. After all of this, she will need to wait until her test results come in (no, not until tomorrow) and then return to the clinic to schedule her first appointment (sorry, there are no appointments for another two weeks.) Although this is a relatively laborious example, it is not too far from what is played out across the country each day as low-income mothers, fathers and children seek to become recipients of social services provided by the government.

Securing free prenatal care is just one piece of the puzzle. If she qualifies, mom will need to go to the WIC office (no, it’s not very close by) to begin receiving nutritional supplements and food during her pregnancy, she may need to go to another office to apply for SNAP (formerly known as Food Stamps), and once the baby is born she may start a similarly arduous journey as she tries to navigate the resource landscape designed to support the nation’s poorest kids, all at the same time that she is hoping to rest and relax with the new addition. It comes as no surprise that many families face challenges in applying for all of these public benefits.

From the barrage of acronyms housed under the umbrella term “welfare,” it appears as if there is a well-established, comprehensive network of services available to provide families the opportunities they deserve. Perhaps if this system functioned perfectly, in an ideal world where everyone who needed something was eligible for it, and everyone who was eligible received it, this would be true. However, there exist so many holes, and so many families who fall through the cracks. How can this fragmented “welfare package” be designed to comprehensively support families, as it proclaims to do? This is the question in the back of my mind as I sit with the other members of the Pre-to-Three team, perched in an office overlooking the river.

We have come together to discuss the survey instrument we are designing for our project on continuity of care for children aged “pre-to-three.” Only 15 minutes in to our discussion, it has become apparent to me that the siloed nature of the public welfare system, as described above, runs deeper than straight service provision. 

“So, would it be possible to match our survey data with data about Home Visiting, or SNAP, or WIC?” I naively ask.

One of the phenomenal community partners on our team replies, “Well, the trouble is that there are a lot of politics involved. You need to get permission from the various agencies, and consent from the families.”

These are the institutionalized walls that separate different services and simultaneously act to separate families from getting the services they need, suddenly made visible to me. It is my hope that our project serves to expose and identify more walls as we look towards a continuous, family-centered social service net.

A Complex Field

Emily E. Davis ’15 studies Cognitive Science. In this post, she reflects on how her conception of the early childhood development field has evolved.

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My interest in early childhood development stemmed from direct work with children: my years of babysitting and working in early childhood care settings. I was surprised when I first met and talked with other student participants in TRI-Lab: Wait… You’ve never taken care of young children? Then what motivated you to be a part of this TRI-Lab? I found myself wondering. I was surprised that many students had such strong academic interests in areas relating to early childhood development without direct experience with children. For me, the personal interest came first, which led to my curiosity about and later academic focus on how children develop language.

Upon entering TRI-Lab, I had a narrow view of what it meant to be involved in the field of early childhood development. Throughout the first semester, my mind was broadened as I learned more about this complex field. On the first day of our retreat in August, I watched in awe as Elizabeth Burke Bryant, Executive Director of Rhode Island KIDS COUNT, sketched out, on a huge sheet of brown paper, a diagram of the early childhood arena in Rhode Island. I had not realized how many government organizations were involved. Nor did I realize the amount of advocacy work that goes on in order to enact policies to improve the welfare of children in Rhode Island.

During the first semester, we learned about many factors that affect early childhood development. While I was already aware that poverty had negative impacts on development, I was not aware of how huge these impacts are. I began to look at early childhood development from perspectives other than the purely cognitive one I was used to.

Most recently, in my small working group, we discussed possible project ideas to improve the executive function and language skills of young English Language Learners. While my mind immediately jumped to direct involvement with children: how about having Brown students volunteer to teach English in Spanish-speaking home day care centers?, my group members had other ideas. The ideas included researching the reasons why Latino parents choose the childcare options they do, creating a policy brief on dual language learning and executive function, and advocating that new public preschools in Rhode Island be dual-language. Working with this group has taught me that there are many strategies for tackling a large issue.

While my interest in language development and my goal to work directly with children as a speech-language pathologist have not changed, my involvement in TRI-Lab has made me aware of the more “behind the scenes” work that is so important in the field of early childhood development.

Learning from Bilingual and Dual-language Programs in Chicago

Kate Nussenbaum ’15, who studies Cognitive Neuroscience, and Science and Society, reflects on her experience over winter break visiting best practice sites in Chicago with Nicole DellaRocco, a Master’s degree candidate in Urban Education Policy Research. Activities sponsored by TRI-Lab over winter break were driven by research needs and learning opportunities emerging from focused interdisciplinary work teams and the larger TRI-Lab cohort of faculty, community practitioners, and students. 

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Returning home from Chicago, I opened my backpack to find a drawing that Ayden had made for me. Ayden is five-years old and attends the Erie Neighborhood House center-based childcare program. He drew what I hope is an inaccurate picture of me while his other classmates played with play dough, built with cardboard and did puzzles. I could walk into a preschool in the Providence area and see kids doing many of the same things, with one notable exception. At Erie, teachers use both English and Spanish to communicate with the children in their classroom, enabling native English speakers to get a taste of the Spanish language while enabling native Spanish speakers to more easily transition to the school environment.

Erie is just one of the four bilingual and dual-language early childhood programs that Nicole and I visited over our two days in Chicago. According to data from the 2010 Census, 28.9 percent of Chicago’s population identifies as Hispanic or Latino, compared to 38.1 percent of Providence’s population. But while Chicago has a large number of bilingual and dual-language preschools and pre-Kindergartens, in part due to Illinois legislation that requires public pre-K’s to offer bilingual programs to meet the needs of their students, Providence has zero. There is only one Spanish-English bilingual center-based preschool program in Rhode Island: Progreso Latino, in Central Falls.

Nicole and I set out for Chicago with a number of questions. Could expanding kids’ access to bilingual and dual-language programs help close the achievement gap between native Spanish and English speakers in Rhode Island? What makes a bilingual or dual-language program successful? What type of program would have the best chance at succeeding in Rhode Island? What are the challenges associated with implementing a bilingual or dual-language program, and what are the benefits?

We met with teachers, students, principals and program directors at four different primarily publicly-funded programs. In addition to Erie House, which receives funding from Head Start, the Department of Education and tuition from some students, we visited the Talcott Elementary public school, the Namaste Charter School and the Inter-American Magnet School. All four schools primarily serve low-income kids from Spanish-speaking homes. While Erie House is a bilingual program that helps kids gradually transition to English before entering a monolingual English Kindergarten, the other three programs are dual-language, meaning they promote academic and social fluency in both English and Spanish for all students. In these programs, students in pre-K classrooms are taught mostly in Spanish, with a little bit more English added to their instruction each year. To reap the benefits of dual-language programs, students must attend for six to seven years, Diego Giraldo, the principal of the Inter-American Magnet School, told us.

Nicole and I left Chicago with more questions than answers. We went in search of a program model that would enable Spanish-speaking children to reach their full cognitive potential and thrive socially, emotionally and academically in school. But our final conversation with Principal Giraldo, really drove home the point that there are many social and political factors that dictate attitudes toward bilingual and dual-language education. Should the goal of early education be to help Spanish-speaking children transition to English as quickly as possible even if that means they might miss the opportunity to become academically fluent in two languages? Should the goal be to enhance children’s academic Spanish skills even if that means delaying their acquisition of academic English?

Still, we came home with some conclusions. As we observed programs, one thing became very clear. The relationship between teachers and students, particularly in preschool, seems more important than the curriculum used. And given the different models of early language education, before we can advocate for the creation of a specific program type, we need to understand the needs and desires of Latino families in Rhode Island. Are their kids in preschool programs? Why or why not? What are their academic goals for their children and what type of early childhood program would meet their needs?

Our trip taught us a lot about different models of early childhood Spanish-English education. But in traveling to Chicago, we realized how little we know about Providence. We need to take a step back, or perhaps forward, and really get to know the population we hope to work with. 

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Learning from West Coast Innovation

As part of TRI-Lab, students in the Health Early Childhood Development seminar were given the opportunity during winter break to conduct research, visit best practice sites, or pursue other learning activities.  Work sponsored by TRI-Lab was driven by research needs and learning opportunities emerging from focused interdisciplinary work teams and the larger TRI-Lab cohort of faculty, community practitioners, and students. 

Alexandra D. Urban ’15, who studies Educational Neuroscience, reflects on her experience over winter break visiting a best practice site in California. Her working group is investigating how hospitals and partner organizations work to ensure continuity of maternal and pediatric care for outpatients.  

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Just this past week, I found myself with health care leaders at Valley Medical Center in San Jose, California.  This impressive medical complex cares for one in four of Santa Clara county residents and houses the only trauma response center in the area.

It was incredible to witness their passion for delivering the best care possible, even after decades in the industry.  Many questions were touched upon, including: How can we effectively address mental health issues?  One step they have taken is to have trained nurses act as the telephone operators so that triage can happen immediately, successfully connecting patients with the services they need.

Another issue they recently tackled was: what can we do to reduce outrageous wait times in the Emergency Room?  They have since implemented “Express Care,” where patients who need, for example, splints and anti-inflammatory medicine for their sprained ankles are directed to the help they need without hours and hours of waiting in the busy ER.  Meanwhile, patients requiring more extensive tests and a longer hospital stay, those with suspected appendicitis for instance, can then be taken more quickly in the actual Emergency Room.  Not only does this streamline care delivery for doctors, but patients are assisted without such delays and end up far more satisfied.

What about prenatal care?  And how are we addressing continuity of care for new mothers and their infants at Valley Medical?  A crucial step they are in the midst of implementing is moving all medical information online.  With this new system, patients and doctors can access the most up-to-date information, all in one place.  Also, as with many large hospitals, this medical center has faced difficulties with communications between departments, meaning that if a soon-to-be mother is diagnosed with depression by her OB, this information might never makes it to her primary care physician.  However, once this patient and all her doctors are able to access and update information on the same online portal, communication will improve and diagnoses will be less likely to fall through the cracks between departments and sectors of the hospital.

Valley Medical has also started a new program entitled “Baby Gateway.”  This initiative connects new mothers with their babies’ pediatricians, face to face, while the mother and baby are still at the hospital immediately following birth.  The idea is that if mothers have already met and heard the importance of their children’s upcoming pediatric appointments from the pediatricians themselves, they will be more likely to bring their infants to these crucial check-ups and immunizations.  The early results are exciting: mothers served by “Baby Gateway” have shown higher rates of attendance at their children’s pediatric appointments, thereby effectively lowering DNKA [Did Not Keep Appointment] rates for the hospital overall.  Since Valley Medical serves a large population of immigrants and low-socioeconomic patients, a demographic in which DNKA rates have been shown to be particularly high, this type of intervention is extremely important.  In fact, Greg Price, Deputy Director of Ambulatory Care at Valley Medical, estimated the DNKA rate to be 20% across departments, and he stressed that any programs aimed at improving no-shows from the current one-in-five ratio would be very welcome.

Lastly, in response to the question of how to address the larger issue of continuity of care, Chris Wilder of the Valley Medical Foundation stated, “we’re the largest hospital in Silicon Valley and we still haven’t figured it out.”  This is a crucial area in medicine currently, one that is gaining both attention and traction at hospitals nationwide.   Many programs are being implemented, some of which are yielding promising results, but much research remains to be done.

This is where our TRI-Lab group comes in.  The more we can learn about why mothers do not bring their infants to pediatric appointments and how we can enhance these doctor appointments themselves, the more effective our future interventions will be to improve the continuity of care for low-income mothers in Rhode Island.  Only then, will we be able to share our knowledge and initiatives with others.

Wilder ended our meeting with a smile: “so let us know what you figure out in Providence – we always want to hear what’s working, near and far!”

Last Class of the Semester

Evelyn Sanchez ’14 was a TRI-Lab intern last summer at Children’s Friend, Rhode Island’s oldest child welfare organization. Aimee Mitchell, the Senior Vice President Programs and Operations at Children’s Friend, is also a TRI-Lab participant, and has worked with Evelyn and other TRI-Lab faculty, students, and community partners over the past semester on the topic of “Family Engagement”.  Evelyn reflects on TRI-Lab’s last class of the fall semester and looks forward to the Lab’s future work.

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Last week, TRI-Lab celebrated its last class of the fall semester. Our three interdisciplinary work groups came together to present their research briefs and project ideas to the entire early childhood development Lab. We’ve worked up to these final project ideas over the course of a semester, and now we’re excited to see which of the projects are chosen by the group to move forward into next semester and next year.

Our group, Family Engagement, came up with two vastly different ideas that show just how broad our topic is in scope. On one hand, we have proposed a new parental visitation model to implement in Rhode Island’s current child welfare system. We believe that changing visitation practices and the way parents interact and engage with the system would ultimately increase reunification rates and ensure the best outcomes for the state’s most vulnerable children.

On the other hand, we have come up on another idea that would give groups of low-income parents small grants with one stipulation: that they invest the funds in their children.  We envision these groups of women meeting — perhaps with the aid of a trained facilitator — to discuss what to do with the money. Our hope is to leave these mothers with tangible skills: budgeting, social capital, communication skills, and the increased understanding that early investment in children is important. We’re calling this idea our “microfinance” idea, although we recognize our idea does not resemble the model that lends at high interest rates and requires loan repayment. The reason we do not have another name is simply that, as far as we know, this idea has yet to be done elsewhere. Our main question is: What happens when you give low-income parents money to invest in their children? We want to find out.

Although our group has worked in the latter half of the semester to research and develop these two project ideas, we were all intrigued and excited by the other groups’ ideas. Should we develop a new curriculum for dual language speakers? Investigate how to reduce Did-Not-Keep-Appointment (DNKA) rates at Hasbro’s Children Hospital? We are currently left wondering which of our many great project ideas will come to fruition.

Our final session, however, showed me that despite each group’s investment in its own ideas, it will not ultimately matter which of the groups’ ideas gets chosen to move forward. The genuine interest and questions that came after each group’s presentation showed that we all share a common goal. After the presentations, we sat around eating Indian food and cake and ice cream and talked excitedly about our project ideas and the winter break projects that TRI-Lab is funding for each group. Whatever project — or projects — move forward will have benefitted from having a passionate group of people work together to leave a positive impact on the children of Rhode Island.