The 2019 John R. Lutzker Lecture featured Dr. Judith Carta, the associate director of the Juniper Gardens Children’s Project, professor of Special Education at the University of Kansas, and a Senior Scientist in the Institute for Life Span Studies. Her science focuses on developing strategies to minimize the effects of poverty on children’s language and social outcomes and developing practices that teachers and parents can use to promote children’s early learning particularly in vulnerable populations.

1. Promoting Community Wide Engagement
in Evidence-Based Prevention
It Takes More than a Village
Judith Carta, Ph.D.
Juniper Gardens Children’s Project
University of Kansas
2019 John R. Lutzker Lecture
Georgia State University
School of Public Health
Atlanta, Georgia
September 9, 2019

2. • I have spent my career doing my own work in prevention
looking for ways to reduce the number of children who enter
school without the early experience needed to learn to read.

3. Using a Community-Wide
Multisector Approach to
Bridge the Word Gap

4. What is the Word Gap?
The disparity in the early
language learning
opportunities often
experienced by children from
lower socioeconomic groups
compared to children from
more advantaged families.

5. 34% of American children entering
kindergarten today lack the basic language
skills they will need to learn to read
60 % of children
from low-income
backgrounds

6. The 30-Million Word Gap in Adult Talk to
Children by Age 4 (Hart & Risley, 1995)
30
Million
Word
Gap

7. The Disparity in Vocabulary Growth
Hart & Risley, 1995

8. Who were the Survey
Respondents?
90%
10%
126
473
204
114
Researcher
EC
Professional
H
ealth
Professional
O
ther

9. The Achievement Gap: Inequality at the Starting Gate
Often results in a gap that extend
into other areas and GROWS over
time.

10. Language is the currency of education!
• Children missing basic literacy skills on school entry are
3 to 4 times more likely to drop out of high school.
• “Skills beget skills”: Children who have basic,
foundational knowledge will find it easier to acquire
more complex skills in the future (Heckman 2008).
• Children with stronger skills at school entry are on a
more favorable pathway toward academic success than
students with weaker initial skills.

11. The Good News!
• We know what it takes to promote a child’s early
language development.
• We have 20 + years of research pointing to the
specific types of behaviors that we can teach
parents and caregivers to do to put children on a
developmental pathway toward school readiness.
• These are behaviors that parents and family
members, child care providers and early educators
can do and embed into their everyday routines.

12. Bridging the Word Gap Initiative Established
to Harness that Research Knowledge
• In 2015, President Obama initiated
Bridging the Word Gap Initiative
with bipartisan support.
• Bridging the Word Gap Research
Network and several other
national initiatives focused on
finding ways to enhance children’s
early language environments to
improve their readiness for school.

13. GOAL of the BWG Research Network
Advance a research agenda for reducing the vocabulary gap of young
children in poverty by enhancing their early language learning experiences

14. • A network funded by Health Resources and Services
Administration (HRSA) of about 200 individuals
working together to advance a national research agenda
to make a difference in children’s early language learning
experience
• Representatives from different disciplines:
• Representatives from different sectors: researchers, practitioners,
policymakers, civic leaders
• Working across diverse settings:
• Home settings, early education/child care, pediatric settings, community settings

15. We have a robust literature of evidence-based practices
for changing caregivers’ behavior in ways that promotes
children’s language growth.
• We have a strong empirical
literature pointing to
evidence-based practices for
promoting children’s early
language.
• We know the active
ingredients or “behavioral
kernels” of those
interventions.

16. Descriptive and intervention research points to adult
responsiveness as the key to promoting children’s
language
§FOLLOWING THE CHILD’S LEAD: Adult talk that follows a child’s
interest (their lead)
§NARRATING CHILDREN’S EVERYDAY ROUTINES: Adult caregivers
talk about what they are doing during daily activities
§TAKING TURNS: Adult follows up child’s response with another

17. We also have emerging evidence
from neuroscience on the
influence of conversational turns
on brain development.

18. Rate of “Conversational Turns” Related to
Enhanced Brain Development in Broca’s Area
Romeo, R., et al. (2018). Journal of Neuroscience 38 (36) 7870-7877; DOI: 10.1523/JNEUROSCI.0484-
18.2018

19. Bad News
• The word hasn’t gotten out how important it is to engage and
interact and talk with children.

20. The Word Gap Should be
Preventable, but….
We still haven’t been able to close the gap in the
quality of early language environments for children
from low- and higher SES households.

21. We need to “Move the Needle” on the Word
Gap!
We need to do more than change behavior.
We need to create a culture shift around the importance of
talking and interacting with young children.

22. How do we move from evidence-based
practice….
‘
• To creating a cultural shift in the way
parents and caring adults think about
their role in shaping a child’s early
language?

23. Strategies for changing behaviors and
creating a culture shift
1. Craft the behavior change message: translate the
“active ingredients” into easy to understand language
2. Employ multiple messengers
3. Create a village: Organize messengers around a
common goal
4. Move Beyond the Village: Create multi-sector
partnerships

24. How Can We Move the
Needle on the “Word Gap”?

25. 1. CRAFT THE MESSAGE
•Make the “Active Ingredients” of interventions
easy to understand and remember
ØBy parents
ØBy the interventionists
•Make Sticky Messages!

26. 30 Million Words Initiative
Dana Suskind, M.D.
Helping Parents Learn
Specific Language-Promoting
Strategies
http://thirtymillionwords.org
/

27. ACTIVE INGREDIENTS
§FOLLOWING THE CHILD’S LEAD:
Adult talk that follows a child’s
interest (their lead)
§ NARRATING CHILDREN’S
EVERYDAY ROUTINES: Adult
caregivers talk about what they are
doing during daily activities
§TAKING TURNS: Adult follows up
child’s response with another
3 T’S
§TUNE IN
§TALK MORE
§TAKING TURNS

29. 2. ENGAGE MORE MESSENGERS
•Expand the reach of the message by enlisting
more partners—especially non-traditional ones

30. WHO ARE THE MESSENGERS?
Home visitors
Early Educators/Child Care Providers
Pediatricians/Nurses/Public Health Providers
Librarians
Museums

31. Home Visitor as the Messenger

32. Home Visiting Interventions

33. • Community-Wide Home
Visiting Intervention
• Teaches Language
Strategies
• Provides Parents with
Feedback about Amount
of Talk and Turns
• Uses LENA to Measure
Home Language
Environment

34. LENA PROVIDES FEEDBACK ABOUT QUANTITY
OF TALK AND CONVERSATIONAL TURNSLENA: “Language Pedometer” Measurement
of the Child’s Language Environment

35. Child Care Providers/Early
Educators as the Messenger

36. Strengths-based
approach to coaching
using the LENA
technology to provide
feedback about
teachers’ interactions
with children

37. Coaching and Feedback for Promoting Talk
and Conversational Turns

38. Pediatricians/Pediatric
Nurses/Public Health Nurses as
the Messenger

41. 3. Create Synergy: Bring
Community Sectors Together
Working Toward a Common Goal
Creating the “Village” through City-Wide Campaigns

42. Too Small to Fail
Weaving Early Brain and Language Development
into the Fabric of Communities

44. Bus shelters Playgrounds Grocery StoresLaundromats
Finding Ways to Encourage Parent-Child
Conversations In Places Where Parents and
Children Go

45. <
Gives parents and
caregivers ideas for things
to talk about while doing
the laundry.
Collaboration between
Too Small to Fail, the
Clinton Foundation, and
the Coin Laundry
Association

47. 4. Bring Together Multiple Community-
Partners to Create Multi-Sector
Collaborative Partnerships
It Takes More than a Village

48. The Promise and the Peril of Building
the Village
We know that trying to achieve
population health goals is not
for the faint of heart.
Only 10% of public health
measures tracked are met
(Fawcett et al, 2010).

49. The Perils: What factors can
contribute to poor results?
1. Lack of shared responsibilities for achieving agreed upon
population-level outcomes: Just getting together doesn’t work
2. Stakeholders often have differing goals or understanding of
the problem: Having common goals is key.
3. Measurement of accomplishments is challenging; measures of
success at the level of the whole community are lacking
4. Incentives for achieving population-level improvement are
rare.

50. Among the 7 Recommendations for
Building Collaborative Partnerships for
Population Health (Fawcett et al., 2010)
1. Establish systems to detect progress toward achieving
population health outcomes and health equity
2. Develop and use action plans that assign
responsibility for changing communities and systems.
3. Establish participatory evaluation systems for
documenting and reviewing progress and making
adjustments.

51. How do we coordinate multi-
sector interventions and evaluate
the process and the outcome?

52. How Our BWG Research Network is Developing
a Community-Wide Multi-Sector Approach for
Bridging the Word Gap
• Working with University of Kansas’ Center for Community Health
and Human Development (Watson-Thompson, Fawcett, et al.,
2019)
• Developed a conceptual model based on community-wide
ecological theory of change (Fawcett, Collie-Akers, Schultz, &
Cupertino, 2013) and the Institute of Medicine’s (2003)
Framework for Collaborative Public Health Action
• Developing a system for monitoring change in actions taken within
sectors focused on the word gap and linking it to population-level
outcomes
• Creating a community-wide action planning guide

53. Our evidence-based multi-level approach
to Word Gap prevention

54. Potential Sectors
for a Bridging the
Word Gap
Community-Wide
Multisector
Intervention

55. Your Community
Action Planning Guide
for Bridging the
Word Gap

56. BWG Action Guide: A Blueprint for
Communities
• Helps bring together community
leaders and grassroots
organizations in activities designed
to promote nurturing language
environments for all children
• Provides a step-by-step blueprint
for a community to plan,
implement, and evaluate strategies
for bridging the word gap
• For each potential sector, it
outlines a range of programs,
policies, and practices to guide
community changes.

58. COMMUNITY CHECKBOX for recording and
monitoring changes within sectors

59. Tracking Community-Level Progress
• The online BWG Checkbox—allows for the tracking of
accomplishments in each sector
• Each accomplishment/event is recorded, described, date and
time documented, and coded by type and importance
• Coding accomplishments measures the implementation of the
BWG action plan (changes in practices, programs, and
policies in the community related to BWG)
• The Checkbox provides the community leadership data-based
feedback for renewal and altering efforts toward the goals.

60. Some questions we can address
• How extensively are BWG strategies implemented across
prioritized sectors (e.g., pediatric health, childcare, home visiting,
etc.)?
• What resources have been leveraged to support the BWG
community initiative?
• What changes in practices, programs, and policies have resulted?
• How are these community-level changes linked to child-family
BWG outcomes?

61. Future Directions for the BWG Research
Network
• Carry out rigorous studies of community-wide multi-
sector work
• Replicate multi-sector interventions across multiple
communities

62. It Takes More than Evidence-Based
Practices…It will take:
• Systematic approaches for scaling up those practices
• New approaches for making the practices easy to remember and
implement and embed into everyday lives.
• New messengers for getting the practices out to all parents and
caring adults in innovative ways
• New ways of getting partners from all across communities to
plan together, work toward achievable goals, monitor their
progress toward the population-level outcomes they are trying
to achieve.

63. Can We Bridge the Gap?
• It will take a village but much more than a village.
• Yes, but it will take the commitment of partners working smart
and focused on common goals, learning from each other, and
learning from data about what’s working to foster the success of
collaborative partnerships.
• This is our vision for evidence-based prevention of the word gap
and beyond that: for improving population health and health
equity.

64. Contact the BWG Research Network
Co-PIs
◦ Dr. Judith Carta
◦ carta@ku.edu
◦ Dr. Charles Greenwood
◦ greenwood@ku.edu
◦ Dr. Dale Walker
◦ walkerd@ku.edu
Project Coordinator
◦ Dr. Alana Schnitz
◦ aschnitz@ku.edu
www.bwgresnet.ku.edu
@BWGResNet
Bridging the Word Gap Research Network
HRSA Award #: UA6MC27762

65. Project Contact
Too Small to Fail http://toosmall.org/
Thirty Million Words-Dr. Dana
Suskind
http://thirtymillionwords.org/
LENA Grow https://www.lena.org/lena-
grow//
Talk with Me Baby-Drs. Ashley
Darcy Mahoney & Jennifer
Stapel-Wax
http://www.talkwithmebaby.org/ab
out

66. ¡ Darcy Mahoney, A., McConnell, S. R., Larson, A. L., Becklenberg, A., Stapel-Wax, J. L. (2019). Where do we go from here? Examining pediatric
and population-level interventions to improve child outcomes. Early Childhood Research Quarterly,
https://doi.org/10.1016/j.escresq.2019.01.009.
¡ Fawcett, S. B., Schultz, J., Collie-Akers, V., Watson-Thompson, J., & Francis, V. (in press). Participatory monitoring and evaluation of community
health initiatives using the Community Check Box evaluation system. In Wallerstein et al. (Ed.), Community-based participatory research for
heath (3rd ed.). San Francisco: Jossey-Bass.
¡ Fawcett, S., Schultz, J., Watson-Thompson, J., Fox, M, & Bremby, R. (2010). Building multisectoral partnerhships for population health and
health equity. Preventing Chronic Disease: Public Health Research, Practice, and Policy, 7, (6), 1-7.
¡ Greenwood, C. R., Carta, J. J., Walker, D., Watson-Thompson, J., Gilkerson, J., Larson, A. L., et al. (2017). Conceptualizing a public health
prevention intervention for bridging the 30 Million Word Gap. Clinical Child and Family Psychology Review, 20(1), 3-24. doi:10.1007/s10567-
017-0223-8
¡ Golinkoff, R. M., Hoff, E. , Rowe, M. L., Tamis-Lemonda, C. S. and Hirsh-Pasek, K. (2019), Language matters: Denying the existence of the
30-Million-Word Gap has serious consequences. Child Dev, 90: 985-992. doi:10.1111/cdev.13128
¡ Hart, R., & Risley, T. R. (1995). Meaningful differences in the everyday experiences of young American children. Baltimore: Brookes.
¡ Heidlage, J. K., Cunningham, J. E., Kaiser, A. P., Trivette, C. M., Barton, E. E., Frey, J. R., & Roberts, M. Y. (2019). The effects of parent-
implemented language interventions on child linguistic outcomes: A meta-analysis. Early Childhood Research Quarterly,
htps://doi.org/10.1016/j.ecresq.2018.12.006
¡ Radesky J.S., Carta J, Bair-Merritt M. (2016). The 30 Million–Word Gap: Relevance for pediatrics. JAMA Pediatrics. Published online July 05,
2016. doi:10.1001/jamapediatrics.2016.1486
¡ Suskind, D. L., Suskind, B., & Lewinter-Suskind, L. (2015). Thirty million words: Building a child’s brain—Tune in, Talk more, Take turns. New
York, NY: Dutton.
¡ Walker, D., et al., (2019). Language intervention research in early childhood care and education: A systematic survey of the literature. Early
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