The undertold story: A leadership program to expand recognition of the importance of early childhood experiences

Abstract

There are considerable data documenting the importance of early experiences for healthy human development. Though widely accepted amongst mental health clinicians, developmental researchers and early childhood policymakers, this information is not well known by much of the public. We describe a specialized program designed for established and emerging leaders in Louisiana, United States of America, to help them become better informed to take action to support young children and their families and to facilitate connections across sectors for greater impact. Conducted annually for 6 years, the program drew leaders from a variety of professional sectors working in every region of the state. To evaluate the effectiveness of the program, we conducted semi‐structured interviews of program graduates and tabulated responses by thematic analysis. We conclude that translation efforts delivered in this kind of format can lead to gains in knowledge among leaders and action to support early childhood development and well‐being.

1. INTRODUCTION

In academic circles, the vital importance of early experiences for human development is widely accepted (Black et al., 2017; Britto et al., 2017; Fox et al., 2010). Such experiences include caregiving relationships, exposure to stresses or trauma, and non‐medical factors such as poverty, structural and historical inequities, and access to resources, all of which may impact children's physical and mental health, development, and well‐being. There is a growing evidence base supporting policy and program interventions that can mitigate negative experiences and improve the mental health and well‐being of young children and their families (Center on the Developing Child, 2016; Gleason et al., 2016). Moreover, a convergence of findings from neuroscience, child development, and economic research have documented the return on investment of early intervention (Knudsen et al., 2006). Thus, a focus on translating research evidence into policies and practices that promote the healthy development of infants and young children, strengthen families and reduce disparities in access to quality mental health care should improve early childhood experiences. Because young children with mental health needs and their families frequently interface with multiple public agencies and systems, these policies and programs require cross‐sector investment and inter‐agency collaboration (Purtle et al., 2022).

In addition, broader acceptance and support of these initiatives, which mostly rely on public funding, require buy‐in about the importance of the issues. Despite the importance of public engagement, there has been limited evidence about translating and disseminating research about infant and early childhood development to various professionals in leadership positions who influence policy development and investment. One highly regarded source of translating research into policy‐ and practice‐relevant information is the Harvard Center on the Developing Child. Their founding mission is to “generate, translate, and apply scientific knowledge that would close the gap between what we know and what we do to improve the lives of children facing adversity” (https://developingchild.harvard.edu/). They regularly produce briefs and mutimedia products that synthesize and draw overarching conclusions from research on the science of early childhood development, all freely available on their website. In addition, the policy arm of the early childhood nonprofit, ZERO TO THREE, translates research on the science of early childhood into responsive policy solutions, creates policy and advocacy resources for federal and state policy influencers, and works directly with policymakers to advance policy solutions that are in the best interest of very young children.

In this paper, we describe the creation of the Early Childhood Policy Leadership Institute (ECPLI), whose mission is to recruit and train leaders from a variety of professional sectors about the importance of early experiences. The goal was translational, that is, to convey important findings from developmental science that have clinical, developmental, educational, and economic implications.

Key findings

1. An interdisciplinary leadership program that was designed to enhance knowledge and support action on behalf of infants and young children was successful.

2. Three in‐person 24‐h sessions permitted presentations by experts and interaction among participants and is a promising strategy for developing early childhood champions.

3. Participants strongly preferred cross‐sector training and indicated that they perceived information on brain development, stress/trauma, and attachment as having the largest impacts on them.

Relevance for infant and early childhood mental health

Choices regarding programmatic funding and policies that support healthy infant and early childhood mental health are often left in the hands of leaders outside the field. It is imperative that wider audiences of people with decision‐making power understand the role of early experience in long‐term health, in an effort to increase and improve funding, policies, and practices that impact very young children and their families. Cross‐sector learning provides a rich opportunity for discussion and collaboration that facilitates such efforts.

There are few programs similar to the program described herein. Table 1 Lists several programs that share some similarities, but they also have important differences. The Erikson Institute program is the most similar because it replicated the program we are describing (the same person designed both), but The Erikson Institute program's area of concentration is Illinois. The Early Childhood Fellows Program offered by the National Conference of State Legislatures (https://www.ncsl.org/human‐services/early‐childhood‐fellows‐program) is single sector, recruiting exclusively state legislators and is primarily concerned with policies about early childhood education. The ZERO TO THREE Fellowship has varied somewhat over the years it has been offered, but it has consistently focused on early childhood practitioners and program administrators rather than a broad coalition of professionals from diverse backgrounds who may not have any background in early childhood development. The Hunt Institute (https://hunt‐institute.org/programs/early‐childhood‐engagement/), which provides a fellowship program specifically for political leaders, also conducts an Early Childhood Summit. In sum, other than the Erikson program that was directly created from ECPLI, the other programs differ in participants and focus from ECPLI.

TABLE 1.

Selected programs similar to ECPLI.

Hosting Institution	Program	Participants	Schedule	Focus
Erikson Institute	Executive Fellows Program	Cross sector leaders in Illinois	6 days in 2 months	Quality early childhood experiences and policy opportunities
National Conference of State Legislatures	Early Childhood Fellows Program	State legislators and staff from around the United States	Two multi‐day in‐person meetings and two webinars	Policies primarily affecting early childhood care and education
ZERO TO THREE	ZERO TO THREE Fellowship Program	Infant mental health practitioners and program administrators	Mentor assignment, one week intensive and meetings at ZTT conferences.	Clinical, research and policy issues relevant to infant mental health
Hunt Institute	Early Childhood Engagement Program and Early Childhood Leadership Summits	Gubernatorial staff, state lawmakers and key early childhood system leaders	Technical assistance to state teams such as legislative early childhood caucus, committee and workgroup leaders	Focus on policy and systems development by state officials.

The importance of early childhood experiences is best known among professionals working in the various fields related to young children. Our goal was to reach a broader array of local leaders who might prove influential in supporting early childhood efforts specific to mental health and well‐being by promoting programmatic, policy, and funding efforts that facilitate safe, stable, nurturing environments for young children. In so doing, we were aware that state‐specific factors (including political environment, legislative priorities for caring for children, overall structure of the child health care community) ought to shape our engagement strategy with these local leaders whom we hoped would become active stakeholders in the decisions impacting children in our state (Albritton et al., 2014). Research suggests that building on existing relationships, leveraging existing relationships within communities, and nurturing long‐term partnerships also are essential to stakeholder engagement (Murphy et al., 2021). Further, evidence suggests that policy leaders such as state mental health agencies, for example, prefer research that is relevant to state residents and that provides data on cost‐effectiveness and budget impact (Purtle et al., 2022).

In creating ECPLI, we determined to recruit and train leaders across Louisiana to champion the well‐being of young children by ensuring that their early experiences are fully supported. We believed that including a diverse network of leaders across institutions, sectors, and areas of expertise, as well as demographic diversity (e.g., region within the state, race, gender, political affiliation) would enrich the experience and maximize the potential for creative collaboration. Initially, we recruited a professionally diverse class of “established and emerging leaders” who included legislators, leaders in state government departments relevant to young children, judges, advocates, funders, and professionals from the business community, not‐for‐profit agencies, and the media, selected to represent all regions of the state. Subsequent classes of fellows were similar to the first group, with some year to year variability and the addition of healthcare, juvenile justice, and law enforcement, as well as professionals and representatives from higher education (see Table 2).

TABLE 2.

Sectors represented at ECPLI.

Sector	Number of ECPLI Fellows
Legislative	11
Judicial	16
Education	9
Health/Mental Health	8
Philanthropy	6
Business	16
Juvenile Justice/Law Enforcement	4
Child Welfare	8
Governor's office	4
Advocacy	11
Media	1
Non‐profit service	7
Local government	2

Dropped out (not included above): 1 business and 1 legislator.

Funding to support the program was from a variety of sources and varied somewhat from year to year. We believed that this kind of program should be provided at limited costs to participants, so we sought and obtained funding from state government departments who were led by individuals who had a stake in promoting child well‐being. Financial support was also provided by local, regional and national foundations and corporate donations. Funding was used to support faculty time, honoraria and travel expenses for invited speakers, and hotel, meals and venue charges for all participants. The fellows covered their own travel expenses.

The structure of the training evolved slightly over the first 2 years, but by year 3, we had settled upon three sessions held monthly in the fall. Sessions began with a dinner and evening presentation, followed by a full day of lectures and discussions on the subsequent day. An informal atmosphere was created to facilitate interaction among the participants, as networking across sectors was seen as integral to the success of the program. For example, ECPLI faculty and guest speakers set an informal tone by using first names, engaging in casual conversation, and encouraging questions and discussion at any time. Further, the structure of the program facilitated opportunities for the speakers to interact with participants, both during presentations (we included ample time for group discussions) and in informal social interactions over meals and between presentations. Small groups of individuals gathered around tables to share meals at each session and the activities at one session, conducted at a rustic retreat center.

After the first year, we invited graduate fellows to attend that session so that all of the fellows had the opportunity to network across cohorts and the current cohort could learn about how program graduates were applying the information they had learned in their work following the training. The final session also included semi‐structured brainstorming and goal setting with small groups of participants that were assigned by areas of interest.

The content presented was intended to provide information to participants about key issues related to early childhood well‐being, including brain development, attachment theory, stress/trauma/deprivation (early adversity), economics of early investment, and early childhood policy. Content evolved over the first 3 years, with more direct focus health disparities, racism, and mental health in subsequent years. The availability of reports such as ZERO TO THREE's State of Babies provided data that fueled conversation about disparities in the field and we sought to elevate that conversation by adding to our roster of guest presenters policy experts and practitioners who expressly focus on the importance of understanding and addressing inequities.

Mulitmedia presentations on the aforementioned topics were from national experts and ECPLI faculty from Tulane University School of Medicine. Speakers (Table 3) were selected based on their established expertise in the various content areas we aimed to address. Speakers relayed anecdotes and demonstrated concepts with video illustrations, which was important to help participants make meaning of the material, particularly those from outside of fields related to young children.

TABLE 3.

ECPLI speakers 2014–2019.

Outside speakers
Vincent Felitti	Kaiser Permanente San Diego (Co‐originator of Adverse Child Experiences study); he described details of the ACE study.
Bryan Samuels	Chapin Hall Institute, University of Chicago (Former Commissioner of the Administration of Children Youth and Families); he described policies affecting children who have experienced maltreatment.
Nathan Fox	University of Maryland (Distinguished University Professor in the Department of Human Development Quantitative Methodology); he described the importance of executive functions and the caregiving experiences that promote them.
Robert Grunewald	Federal Reserve of Minneapolis (Economist); he described the benefits of economic investments in early childhood education.
Robert Pianta	University of Virginia (Dean of the School of Education and Human Development); he described the experiences in childcare and pre‐K settings that promote healthy development.
Geoffrey Nagle	Erikson Institute (President); he discussed state spending on early childhood, state policy opportunities and how they translate to improved school readiness, the economics of early childhood investment especially at the state level, and the advantages of early versus later educational interventions on subsequent school success.
Charles A. Nelson	Harvard Medical School and Boston Children's Hospital (Richard David Scott Chair in Pediatric Developmental Medicine Research); he described brain development, sensitive periods, and how various types of adversity, including deprivation and threat, affect the developing brain.
Lindsay Usry	ZERO TO THREE (Director of Infant and Early Childhood Mental Health); she discussed needs and opportunities related to early childhood policy and systems building at the state and federal levels, as well as the state of young children's well‐being in Louisiana.
Robert Dugger	Ready Nation (Founder and Managing Partner); he described the importance of business investment in early childhood and the national security issues involved.
Matthew Melmed	ZERO TO THREE (Executive Director); he discussed key policy issues of early childhood and infant and early childhood mental health.
Kandace Thomas	Irving Harris Foundation (Senior Program Officer); she described policy and systems changes necessary to promote well‐being in early childhood.
Liz Huntley	Ready Nation (Civil Litigator and Child Advocate); she described the importance of early care and education settings for longterm well‐being based on lived experiences of serious adversity.
Sarah Watamura	University of Denver (Associate Professor of Developmental Psychology); she described the complexities of the effects of stress on early childhood development.
Richard Hazelton	Ready Nation (Former CEO of Corning Dow); he made the business case for investment in early childhood education.
Arthur Rolnick	University of Minnesota (Senior Fellow at the Humphrey School of Public Affairs at the University of Minnesota and former Senior Vice President and Director of Research at the Federal Reserve Bank of Minneapolis); he discussed examples of successful economic investments in early childhood programs.
Myra Jones‐Taylor	ZERO TO THREE (Chief Policy Officer); she discussed national early childhood policy priorities and discussed findings from a data analysis on early childhood wellbeing in Louisiana.
Tulane University School of Medicine Faculty Speakers
Charles H. Zeanah, Jr.	He discussed attachment and trauma.
Mary Margaret Gleason	She discussed supporting infant and early childhood mental health in pediatric primary care settings.
Sarah Hinshaw	She described infant and early childhood mental health programs, policies, and gaps in care in Louisiana.
Julianna Finelli	She described perinatal mental health programs, policies, and gaps in care in Louisiana.

One highlight that became a regular presentation after it was introduced in Year 3 was the video case presentation by an ECPLI faculty member and experienced clinician, detailing the dyadic psychotherapy conducted with a toddler who witnessed the murder of her mother. The case engaged and moved the participants on a deeply emotional level, while also illustrating concepts covered in the training, namely development, attachment, and both the importance of relationships and the effectiveness of intervention, as well as the profound effects of severe trauma on a very young child.

Though we received formal and informal feedback from participants each year, the feedback forms we used were brief and mostly checklists. They identified speakers and/or content that was helpful (or not) as well as feedback about venues, meals, and logistics. We determined that it would be useful to conduct a more systematic and in‐depth evaluation of the effect of the program on participants. Other than predicting that the program had been a positive experience and had led to useful changes in perspective and concrete actions, we had no specific predictions about most of the questions covered in the interview, as our goal was to generate descriptive data that might prove useful to us and to others interested in this approach. Beyond perceptions of the training experience from interviews, we also report on tangible outcomes that participants credited to ECPLI.

2. METHODS

2.1. Participants

A total of 105 professionals were recruited as ECPLI Fellows from 2014 to 2019 based on being established or emerging leaders in Louisiana. They were selected in part based on their interest or potential interest in the importance of early childhood issues for their professional sectors, as well as holding professional positions that may have a critical impact on policy or practice related to young children (e.g., a legislator who sat on the appropriations committee, a division leader in the state child welfare agency, etc.). Recommendations for recruiting fellows came from ECPLI faculty and from alumni. In fact, 64% of participants were referred by ECPLI alumni, whereas only 36% were faculty recruits. Because the first year's cohort was exclusively faculty recruits, however, we note that 74% of participants from years 2 through 3 were alumni referrals. In the first 6 years of ECPLI, two fellows dropped out without completing the training, one from the business sector and one legislator; they were not contacted for interviews because their participation was so limited that they could not respond to which aspects of the program were most helpful, informative, surprising, and so forth. In addition, because they represented less than 2% of participants that we could not identify meaningful trends from their responses.

Each cohort was selected to represent multiple sectors (see Table 2) and to reflect geographic, gender, racial, professional, and political diversity. Of the 103 ECPLI graduate fellows, we were able to contact 91. Only one of those contacted declined to be interviewed, leaving 90 fellows who were interviewed. Mirroring the total participant pool, interviewees were 60% female (N = 54) and 40% male (N = 36), and 70% White (one of Hispanic ethnicity) and 24% Black. Over time, the proportion of Black fellows increased to a closer approximation of state demographics: in 2014 they were 15.4% and in 2019 they were 42% of the fellows. In 2023, the state was 61.25% White and 32.17% Black (https://worldpopulationreview.com/states/louisiana‐population).

2.2. Measure

A semi‐structured interview, designed to be roughly 30 min in length, was used to query participants’ experiences with and perspectives about the program. Interviewees were encouraged to elaborate on their responses until they were satisfied they had answered each probe fully. The interview was administered by trained research assistants who were unknown to participants. A copy of the interview is included as SOL material.

2.3. Procedure

Interviewers contacted ECPLI Fellows, invited them to participate in the interview, obtained consent, and conducted a recorded interview via videoconferencing or telephone (when videoconferencing was unavailable). ECPLI participants were queried primarily using open‐ended questions about the content that impacted them the most, what they gained from the experience, what surprised or challenged them the most, and how satisfied they were with the ECPLI experience; their perceived knowledge about program content prior to participating also was self‐rated on a 4‐point Likert scale, and they were asked about how the experience matched their prior expectations: “did not meet,” “met,” or “exceeded” expectations. The interviews were conducted over a period of roughly 15 months, meaning that the time since participants completed training ranged from 1 to 5 years.

Recorded interviews were transcribed, then all 90 interviews were coded by a trained research assistant who had not administered interviews and who was unfamiliar with participants. A second coder, who was not naïve to participants, coded the first 50 interviews. For all binary responses (e.g., did the experience impact your work – yes/no) and for multiple choice questions (prior knowledge rated on a 3‐ or 4‐point scale), agreement between coders was 100%.

For open‐ended content questions, each coder classified responses into one of several content areas. There was 86% agreement about responses to what fellows gained from the experience, 86% agreement about what was surprising or challenging about the content, 84% agreement about the content that had the biggest impact, and 92% agreement about which content areas were new to participants. Interrater reliability was calculated based on content areas noted by one coder but not by the other. This was a conservative estimate of agreements because it did not include agreement about content areas not mentioned. Disagreements about responses were resolved by conferencing among the coders following additional review of responses.

3. RESULTS

3.1. Knowledge beforehand

Participants were queried about how much knowledge about early childhood issues they had before participating in ECPLI. Based on their responses, 19% indicated “not much” prior knowledge, 44% indicated “some” prior knowledge, 27% indicated “a fair amount” of prior knowledge, and 10% indicated “a lot” of prior knowledge.

3.2. Did ECPLI meet your expectations?

Most participants indicated that the experience “exceeded” (n = 50, 56%) or “met” their expectations (n = 36, 40%). Only one participant said that their expectations were “not met,” indicating they were hoping for more information on policy. One participant was not asked the question, one said that they didn't recall, and one said that the experience was “different” than what they had expected, but they did not provide more details.

3.3. Did ECPLI influence your work?

Strikingly, 98% of participants (n = 88) indicated that the experience of ECPLI had influenced their work. One participant said it had not influenced their work, and another one said they had retired.

3.4. Recommending to colleagues

Three quarters (76%) of fellows reported having recommended the fellowship experience to a colleague. Most of those who had not recommended the training to a colleague spontaneously offered that they would do so.

3.5. ECPLI content

Participants were asked four questions about the content of the trainings: (1) What did you gain from participating in ECPLI? (2) What surprised or challenged you the most about the information you heard? (3) What information had the biggest impact on you? and (4) What content was new for you? Responses were coded into various content areas. These areas were derived from actual responses rather than determined a priori, though they were, of course, anchored by the content of the presentations. Figures 1, 2, 3, 4 display the number of responses for each thematic area for each of the questions. Some participants cited more than one content area in response to the questions, so answers for each question have different totals.

FIGURE 1.

What knowledge did you gain from participating in ECPLI?. “Participants” refers to other ECPLI fellows.

FIGURE 2.

What surprised or challenged you the most. ”Participants” refers to other ECPLI fellows.

FIGURE 3.

What information made the biggest impact on you?

FIGURE 4.

What content was newest for you?. ”Participants” refers to other ECPLI fellows.

The content areas included brain development and brain science, trauma/stress/deprivation (includes adverse childhood experiences), attachment, economics of early childhood investment, importance of early experiences, early childhood policy, equity for young children, experience with fellow participants, as well as “all,” meaning all of the information, “none,” meaning nothing or none of the information, “not asked,” meaning the question was not posed, and “don't recall” for one participant in response to one question. Regarding what participants gained from the experience, interviewees referred to the networking opportunity that the training afforded them with a variety of colleagues in different sectors. Regarding what surprised/challenged them, some participants were impressed by the seriousness and commitment of their co‐fellows. Others were surprised or challenged by the different political views of members of their cohort, suggesting some tension between people who all agreed on the importance of parents and families and indicated support of quality early childhood education. For example, some participants felt that there has been an erosion in family values in recent decades and overreliance on government solutions rather than individuals taking responsibility, while others highlighted historical injustices and current disparities. These discrepancies lent themselves to both large group discussions during sessions, with participants elaborating on their differeing perspectives (e.g., the rationale for supporting extended family leave), as well as smaller, more private conversations outside of sessions. The most tension arose during the second session of the program, when health equity was explicitly addressed. At this point in the program, participants had already gotten to know one another and were fairly comfortable raising and responding to concerns. Further, ECPLI faculty observed that the professionalism of participants and the flexible format of the program allowed for information to be exchanged (large group format) and emotional reactions to be processed (outside of sessions, with more trusted colleagues).

3.6. Improvements needed

Fellows were asked their impressions about what improvements were needed in Louisiana, tapping into how their opinions about matters related to young children have been informed by their experience in ECPLI. Their responses were clustered into three major areas. First, the fellows emphasized the need for greater public awareness about the importance of early childhood experiences. This included both parent education and empowerment and urging those individuals with platforms (e.g., mayors, district attorneys, other elected officials) to raise their voices about the importance of early childhood. Second, they focused on funding priorities. They asserted that it is crucial to engage both business and government to support these priorities. In fact, they asserted that businesses should make early childhood part of their policies. They also indicated the importance of recognizing the need to focus on funding for children before they reach pre‐K. Third, some fellows advocated for improvements in early childhood systems, with regard to integration and investment. One fellow noted, “I think greater investment in the early childhood system—more integration of our health and education systems to make sure that families don't fall through the cracks—would go a long way in improving outcomes,”​ and another expressed that, “We as a community need to be paying a lot more attention to early childhood experiences.”

3.7. Cross‐sector versus within sector training

Every interviewee said that they preferred the exposure to professionals from other fields that cross‐sector training entailed rather than wishing that the training had been keyed only to those within their sectors. Several noted this as a distinguishing feature of the program that they valued. As noted previously, this posed a challenge for some, especially around politically charged beliefs that were expressed (“I think what surprised me is the perspectives of some of the folks that were in my cohort…”). However, the atmosphere promoted a dialog and offered the opportunity for scientific information and differing opinions to be considered. More tangibly, the cross‐sector approach facilitated relationship building between leaders in business and government. Given the importance of promoting policy and funding strategies both within and across sectors, these relationships may prove central to developing strategies to support early childhood efforts.

3.8. Initiatives that emerged following training

We were explicit each year to make clear that we were not specifically endorsing nor recruiting support for any specific policies or legislation. Instead, we were providing information that was highly relevant to promoting positive outcomes in our youngest citizens to leaders who were positioned to make use of the information to enhance the experiences of the state's youngest and most vulnerable citizens. We encouraged each fellow to apply what they learned in whatever way seemed important in their particular sector, and we encouraged collaboration among the fellows when that seemed appropriate.

In fact, a number of regional and statewide initiatives important for young children were developed by fellows’ efforts following training. These are detailed in Table 4, organized by whether they were statewide or region‐specific projects. Fellows engaged in myriad initiatives, ranging from legislation and programmatic implementation to expanded leadership development. We include the number of fellows primarily responsible for the initiatives, though we should be clear that other fellows were involved in many of these initiatives as valuable supporters, partners, or content experts. Though no single type of collaboration nor area of intended impact (e.g., child welfare, education, mental health) emerged as a trend, it is noteworthy that most of the efforts involved more than one fellow, and nearly all of the efforts that emerged involving more than one fellow included fellows from different sectors. A total of 26 fellows (unduplicated) were involved in the initiatives in Table 4.

TABLE 4.

Initiatives undertaken following ECPLI training.

Statewide initiatives (Legislation)
1) Legislation passed to create an Early Childhood Care and Education Commission to create a vision and framework for the future of early childhood care and education in Louisiana.	2 fellows (legislators)
2) Legislation passed to require urgency about identifying potential kin placements for young children in foster care, as well as highlighting the importance of stability in foster care placements and the harms of placememnt disruptions for young children.	2 fellows (business and judiciary)
3) Legislation that authorized funding to recreate a statewide infant and early childhood mental health supports and services program for families of young children. ($27 million over 3 years)	1 fellow (advocate)
Statewide initiatives (Other)
4) Creation of a statewide plan to promote trauma informed care using a collective impact model to build bridges between non‐traditional partners, shift mental models about conflict and healing, measure progress of complex work with children and families, and facilitate communication with systems leaders and highly affected communities.	1 fellow (state government)
5) Creation of a not‐for‐profit institute to support foster care and adoptions, including regular educational experiences for legislators about the challenges inherent for children in foster care and those adopted.	3 fellows (business, legislature, judiciary)
6) Adoption of a statewide program—The Quality Parenting Initiative – to enhance the quality of foster care provided to children in the custody of the state by promoting communication, collaboration and consistency in the lives of young children.	4 fellows (2 state government, business, judiciary)
7) Statewide promotion of Trust‐Based Relational Intervention, designed to enhance trauma informed care provided by foster parents to children placed with them.	3 fellows (state government, health, business)
Regional initiatives
8) A city‐wide program established to help connect parents of young children to a network of resources available to them.	1 fellow (city government)
9) An Early Childhood Policy Summit with more than 60 CEOs and elected officials reaching consensus on an action plan to improve early childhood outcomes in a particular area of the state.	6 fellows (judiciary, advocate, city government, school board, business, funder)
10) A local foundation and city government raised $6 million dollars to expand the number of subsidized seats for children birth to 2 years. Outcomes of children in these seats are being tracked by the local foundation.	5 fellows (funder, city government, business, advocate, education)
11) A committed team of business leaders used existing tax credits to purchase curriculum materials for infants and toddlers in childcare centers that accept public payments.	1 fellow (business)
12) Funds from existing tax credits used to provide LENA pedometers (language environment analysis) to childcare centers to encourage increased language interaction. These centers showed significant improvement in CLASS performance scores (how quality of childcare is evaluated in Louisiana).	2 fellows (business, advocate)

And though some initiatives are focused on all children and adolescents, not just young children (i.e., creation of a not‐for‐profit institute to support foster care and adoptions), the fact that young children are included specifically in these programs and policies is notable. We acknowledge that we have no way of knowing which of these initiatives might have happened without ECPLI, but we only listed those in which ECPLI was specifically acknowledged by the graduate fellows involved. The types of opportunities that have arisen from ECPLI are perhaps best expressed by the fellows, themselves, such as the following statement from an Executive Director of a policy and advocacy organization and an advocate for children, who was referred to the program by an alum:

“ECPLI gave me a mission by showing me what could be if Louisiana pulled together the best research on what children need with the best policy solutions to get us there as a state. As a result of my time in ECPLI, I championed a new $27 M investment in infant and early childhood mental health by bringing back Early Childhood Supports and Services. Because of ECPLI I had the talking points and the perspective to get the messaging together to make that investment happen and I was able to leverage legislators who had gone through ECPLI to support the cause and make the investment a reality.”

3.9. Testimonial support

In addition to these tangible initiatives, there were other more subtle and harder to quantify effects of the training on participants. For example, one individual noted, “There were very influential legislators in my group who sit on important financial commitees. I was there 2 weeks ago testifying, and I'm looking across [at the Committee members] and there was this legislator smiling—you know, we know each other now…because we went through this formative experience together, and that matters.” Another reported, “I started working more aggressively at the state level with policymakers to really formulate policy that would create more access…for young children. So I'd say my focus on birth to three and my advocacy for that has increased significantly.” Similarly, another graduate fellow said, “I felt like I got what I needed to be an effective leader, an advocate and organizational leader as a result of this experience.” Several participants expressed profound changes in their professional and personal views. For instance, one judge said, “ECPLI has totally changed my mindset, it has totally led me to be more proactive in my position as…a judge. And so as you can tell, I can't say enough about how it affected me and my job and how I now view my responsibilities.” This judge referred a law enforcement officer to the program, who later brought ACEs training to his staff “…so they could better understand why certain people may act the way they do…it was eye‐opening to them.” And on a personal level, one participant stated, “Frankly, it makes me approach parenting a little bit differently,” while another participant expressed how dramatically it transformed her worldview by reorienting her focus to the earliest years.​

4. DISCUSSION

The present study used semistructured interviews to explore the impressions and experiences of a diverse and cross‐sector group of state leaders who participated in a longitudinal and interactive educational program with experts in infant and early childhood development and mental health. The goals of the training, which was presented annually for 6 years, were to translate several decades of research on young children's brain and behavioral development and to make information about the importance of early childhood experiences accessible and useful to leaders in varied professional sectors. We sought to provide this in a comfortable environment that was rich in professional and demographic diversity—which might not occur naturally—to allow for relationship building and creative thinking about policy and practice as related to early childhood well‐being. We also built in many opportunities for discussion—with speakers and among fellows in small and large groups. Based on their interview responses and on initiatives that they created following the training, fellows’ responses to the training were overwhelmingly positive. Not only did the majority of fellows indicate that the experience met or exceeded their expectations, but all but one fellow said that the experience had been influential in their professional roles.

The content provided was perceived to be important, with different fellows finding different content areas most interesting, surprising, or new. In fact, it is notable that no single content area reached 50% in response to the questions about the effects on participants. Across the four content areas in Figures 1, 2, 3, 4, the most commonly cited areas that participants felt had the biggest impact on them were early brain development, the impact of stress/trauma/deprivation, and attachment. While interview data did not systematically allow for a fuller understanding of why these topics resonanted with participants, the authors’ interactions with participants provide some insight about the reasons, which we suspect are largely related to their prior lack of knowledge regarding the scientific basis of our understanding of early childhood. Prior to participation, few participants realized the extent to which early experiences affect the structure and function of the brain; participants were also impressed by the high quality presentation of the information, as they were able to hear directly from a leading expert/researcher on brain development. Stress and trauma were compelling because, again, few people had realized how profoundly young children are affected by adversity; videotaped examples of children's responses to trauma/treatment were emotionally moving, and the ACE study was relatable, yet new, information for participants. Like learning about ACEs, learning about attachment resonanted because it was relatable personally and intuitively as a central component of healthy social and emotional development; participants were often heard talking with one another about how the attachment lens helped them think about their own experiences.

Some responses were unanticipated. For example, when asked what they gained from participating in ECPLI, a number of participants (28%) discussed the networking opportunities they gained from participating in the training with colleagues across sectors. Interestingly, almost 18% of participants referenced their colleagues when asked what surprised or challenged them; some reported being impressed by the seriousness of their cohort in engaging with the issues, while others reported feeling surprised and challenged by the different political views and perspectives of their co‐fellows. This perhaps derived from our intentionality in selecting fellows who represented diversity of lived experiences and political perspectives. In any case, it was clear that the cross sector make‐up of the cohorts was valued, as all interviewees stated that they preferred the varied sector make‐up rather than training with individuals exclusively from their single sector. This feature distinguishes ECPLI from other similar efforts to translate field‐specific knowledge into practice across sectors.

4.1. Strengths and limitations

The strengths of this descriptive study are that we were able to reach 90% of those who had engaged in the leadership program and obtain complete data from them. The consistency of major topics across all 6 years of the program allowed for the interviews to be consistent in assessing content. The semi‐structured interview allowed us to get more detailed and nuanced descriptions and insights from participants about their experiences than could be captured in a quantitative study.

There were also limitations to this evaluation. We primarily relied on one source, a retrospective interview, for our findings. The range of time from completion of the fellowship to the interview ranged from 1 to 5 years. This likely disadvantaged fellows from the earliest years in their ability to provide detailed feedback. Because most participants in the program were recruited by alumni, and because we offered the program with all expenses covered, there may have been a social desirability bias in responding to interview questions. We attempted to mitigate this by having interviews conducted by trained research assistants who were unknown to the participants. Also, we did not capture the more subtle ways in which the program facilitated cross sector collegiality and a sense of sharing a common mission, which many graduates have reported to us unsolicited over the years.

4.2. Successes and lessons learned

Common attempts to engage policymakers, such as dissemination of fact sheets and brief testimony, may not be sufficient to engage them meaningfully with the content provided. This study sought to examine the potential benefits of a more concentrated approach to engagement through a longitudinal educational program for key individuals in leadership positions. We demonstrated the feasibility of engaging busy professionals in a longitudinal and interactive learning experience and sustaining contact with them over time through informal relationships, professional interactions, and inclusion in subsequent ECPLI sessions as alums. We also demonstrated that the experience and information learned had meaningful impacts on their work.

This study adds qualitative data that can be used to help develop and refine methods of engaging professionals across sectors and building capacity for policy engagement, though we emphasize the importance of local adaptation as essential to a program's success. In addition to data about the importance of early experiences, we found videos and real life stories as illustrations of lived experiences were especially compelling in engaging participants and facilitating the development of their interest in early childhood.

Engaging leaders to become active as stakeholders of young children's well‐being is an ongoing and relationship‐based process; we believe that our emphasis on facilitating relationships among fellows across professional sectors contributed to the success of the program by creating opportunities to think more broadly than single‐sector training may allow, thereby encouraging professional growth and creativity. Moving forward, establishing strategies for capitalizing on momentum via planned communication and dissemination will be critical, as well as establishing ongoing processes for assessing the program and its impact over time (Albritton et al., 2014).

While overall a strength, the variety of backgrounds and perspectives of the fellows was also a challenge. Intense discussions that arose during training sessions in combination with the availability of data around issues of equity, for example, led to a more intentional focus on equity and access to resources in more recent trainings. In the politically polarized atmosphere of recent years, this will likely continue to be a significant challenge. We learned from participants, for example, that the term “trauma‐informed” could trigger immediate opposition in some legislators, and recent politicized backlash to the concepts of social emotional learning and mental health across the country will need to be taken into account in planning for future conversations.

We conclude with a quote from one of our fellows: “…this work has been going on for decades and is an undertold story.” Based on our results, we encourage continued efforts to translate the growing evidence base supporting the importance of early childhood experiences for those who can make a difference and to create learning and leadership development environments that facilitate the growth of relationships amongst professionals from different sectors.

CONFLICT OF INTEREST STATEMENT

Charles H. Zeanah received royalties from Guilford Press and Harvard Press; grant support from Irving Harris Foundation, National Institute of Mental Health, National Institute of Heart, Lung and Blood, and Substance Abuse and Mental Health Services Administration; Consultant/Mentor support from Baby's First Years, and Roop Zainab Rana (ZTT Fellow). All other authors have no disclosures.

Hinshaw, S. , Finelli, J. , Usry, L. , Knable, C. , Nagle, G. , & Zeanah, C. H. (2025). The Undertold Story: A Leadership Program to Expand Recognition of the Importance of Early Childhood Experiences. Infant Mental Health Journal, 46, 215–227. 10.1002/imhj.22155

DATA AVAILABILITY STATEMENT

The authors did not request open data in the consents, so data from this study are not publicly available.