Leaders in early childhood services see kids falling through the cracks. They also see solutions.

A three-year-old child at Compass Family Services, an organization based in the Tenderloin, was playing with Mr. Potato Head figures during speech therapy one day when he declared in Spanish about one of the toys: “He died.” 

It was the first time the child was able to express that he had memories of an incident his caregivers assumed he’d forgotten. At a very young age, he had witnessed his father die of a heart attack. The episode alerted the adults around him that he likely needed trauma support as well as speech therapy.

The story, relayed by Compass Program Director Heidi Lamar, gives an example of just one type of early intervention that many kids need but don’t consistently get. 

Why is that? In their recently published white paper, leaders at Compass and two other organizations, Wu Yee Children’s Services and the Felton Institute, lay out how systemic factors interrupt service delivery, leaving children behind. The paper proposes several solutions: Agencies that handle these services need to coordinate better; training programs should expand to produce more specialists to serve kids and families; and investments should be made in proven programs. The white paper surveyed 400 people and sought input from more than a dozen organizations, and now that it’s out, the authors are asking decision-makers to enact their solutions.

“I've been doing this work for 30 years and I've seen generations of kids fall off the cliff,” said Dr. Yohana Quiróz, chief operations officer at the Felton Institute and one of the paper’s co-authors. Felton provides childcare, disability screening, and an array of other family services. “Families are having to navigate so many challenges getting these services that they're legally entitled to get. And providers are trying to figure out how to give these services.” 

Systemic racism, sexism, ableism, classism, and other forms of discrimination result in enormous disparities in “kindergarten readiness,” a measurement of how well kids can speak and how far along they are in learning letters and numbers. Overall, nearly 70% of kids are kindergarten-ready when they’re assessed. By comparison, under 60% of Black children and less than half of Latino kids meet that standard. Just 45% of special needs children are kindergarten-ready.

Lack of coordination

Interventions in early childhood can help kids meet developmental milestones. But getting and keeping these services can be difficult, sometimes due to where the child lives. 

Many parents gain access to early interventions, like speech therapy, through nonprofit organizations based in their communities, some of which also provide daycare, play groups, or other important services. 

But the specialists who provide that care are generally not employed by the nonprofit; they are contractors deployed by a state-run agency. They might only visit the child’s community to see clients — if they agree to go there. They can, and do, refuse.

Compass, in the Tenderloin, has struggled in the past to convince specialists to travel here. Compass’ Lamar, another of the white paper’s co-authors, has found herself having to call around, asking contractors to work with kids in this neighborhood. She was rebuffed again and again.

The Tenderloin has the highest concentration of young children in the city, but “that’s not what you see in the headlines,” Lamar said. The area’s positive aspects are rarely represented in the media, which is dominated by stories about drugs, homelessness, and instances of violence, so it’s seen as dangerous. “Providers say, ‘I’m sorry, I don’t feel safe there,’” she said.

She added that it’s dismaying to hear the place where she and her colleagues work and live referred to as too dirty or scary to visit even just once a week. 

Another problem is a bureaucratic hurdle that arises when a kid turns three. At that point, the responsibility for providing specialists shifts from the state agency to the local school district. The handoff rarely goes smoothly. Case workers are supposed to follow a whole schedule of referrals, records transfers, and appointments, but often the transition requires intervention from nonprofits or parents to prevent months or years of delay.

Even after this transition is complete, the kid won’t receive care at their school — their parents must take them to a separate location, usually in the middle of the day. That’s out of the question for many working parents.

Navigating all of this was so stressful to one mother, Quiróz said, that it literally gave her a minor heart attack. She couldn’t see how to get her child to the specialist without quitting her job, which would have left her unable to pay rent. So instead, she gave up on getting her child services through the district. 

One solution that the Felton Institute has worked out: Get nonprofit providers authorized to do this work on behalf of state agencies, the school district, or both. That sidesteps needing to persuade outside specialists to travel to work with children under age three; and it lets these kids continue receiving the services at the same location as they get older, rather than trekking to a district site. That also helps the district make the services kids need more accessible to families in a timely manner, Quiróz said.

The white paper lays out more recommendations to get at the roots of these problems. Agencies should collect and share data about who needs services, whether and how quickly they’re getting them, and how well they’re working, the paper says. And a system of care, bringing together city and state agencies and nonprofit organizations, should be established. Then, more care coordinators should be hired into that system to handle referrals, screenings, transfers, and communication between different agencies. Right now, nonprofit workers often do that work for free. 

“These services work, but only when they’re available to our families and when our educators know about them, and when there’s coordination,” said Cheryl Horney, chief program officer at Wu Yee Children’s Services.

Staffing crunch

Even if every agency and nonprofit were working hand in glove with one another, local service providers would still face another problem: A workforce shortage. There are too few early childhood educators, special education teachers, speech-language pathologists, and early-intervention specialists to meet the needs of every child, and the pipelines producing them are too narrow, according to the white paper. 

Colleges and other institutions are not producing educators and specialists at the rate that employers want to hire them. There are few doctoral programs in the state. Master’s programs often have small classes, with just a few dozen graduates a year, because students have to be closely monitored by supervisors. 

Advanced credentials are also expensive, which narrows the pool of future graduates even more and makes it less likely that therapists and other care providers  have the same primary language, culture, and background as the children they work with.

”When a therapist speaks the same language, it builds immediate trust and improves the

effectiveness of the intervention,” Horney said. “Currently, there is a shortage of therapists in general and those that are bilingual in any two languages [are] rare.”

Many professionals already in the field do come from the same racial or socio-economic groups as the kids they work with, but they lack the advanced degrees necessary to provide the services that are in such high demand. So in some cases, organizations have encouraged their staff to get specialized training. Wu Yee, Horney said, offers staff professional development training, stipends for tuition, and other certification initiatives. In addition to stipends for staff, Compass has training programs to help parents who receive their services get the credentials necessary to get jobs in childcare. And San Francisco agencies offer some low-cost courses and tuition assistance. 

But even with the cost barrier lowered, getting additional certifications is extremely time-consuming. 

Merced Rocha, a lead teacher at Wu Yee, started working at the organization with just a high school diploma under her belt. Over the years, she pursued bachelor’s and master’s degrees. Her degree programs required her to complete internship hours — for no pay — and she had to use vacation time to do so. 

“I can understand why some teachers don’t want to get a special education degree,” Rocha said. 

Educators who can get those kinds of degrees earn more and are better equipped to build supportive relationships with their charges. Research also indicates that the increased training leads to better social-emotional and language outcomes for kids, Horney said. So the white paper’s authors call for the expansion of existing low-cost education programs, and for financial support to cover tuition, books, and field experience hours for people hoping to take on those sorely needed roles. 

Improving the system

Now the white paper’s authors are making the rounds with officials and partner agencies, presenting their potential solutions and advocating for greater investments from the city.

Quiróz said the authors have presented their findings to leaders at the city’s Department of Early Childhood, who have been open to feedback and finding ways to improve the system. City and state agencies have initiated conversations to develop closer partnerships. The authors have also met with the mayor’s office and district supervisors, and are talking with philanthropists who are in a position to fill the immense funding gaps in systems of care. 

The white paper also points to federal and state funds that could provide stable, long-term financial support for critical programs. And San Francisco already has funds set aside to support families with young children. 

The revenues from a 2018 measure nicknamed “Baby Proposition C” (to distinguish it from an earlier Proposition C that poured comparatively more money into homelessness services) are designated for early education and childcare. At the end of April, Mayor Daniel Lurie announced that he’d use some of that money to expand daycare availability. But several hundred million dollars are still in that fund, and could significantly alleviate the pressures on the city’s early childhood intervention system. 

Compared with deeply controversial and mind-bogglingly expensive problems like homelessness and the housing crisis, said Compass Executive Director Erica Kisch, “this feels solvable.”